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HARVARD  MEDICAL 
ALUMNI  BULLETIN 


Sept./Oct.  1974 


Listening  to  the  Student  Perspective 


dMf  '<  f 


Why  add  Librium  (chiordiazepoxide  hci 
to  your  cardiovascular  regimen? 


jea 


Excessive  anxiety  in 
susceptible  patients  can 
set  in  motion  a  chain  of 
responses  which  add  to 
the  heart's  work  and 
thereby  increase  the 
possibility  of  cardio- 
vascular complications.  Furthermore, 
intense  anxietv  mav  interfere  with 
effective  medical  management  since 
some  patients,  in  an  attempt  to  deny 
their  illness,  may  resist  acceptance 
of  necessary  medication, 
dietary  restrictions 
and  other  therapeutic 
directives.  When 
counseling  and 
reassurance 
alone  are  inad- 
equate to 


relieve  undue  anxietv,  ad 
junctive  Librium  (chlordi-J 
azepoxide    HCI)    ma\ 
beneficial. 


Ik 

jen 


"Specific" for  anxiety 

reduction... 

wide  margin  of  safety 

Librium  is  used  as  an  adjunct  to 
primary  cardiovascular  medica- 
tions, since  it  acts  directly  on  the 
central  nervous  system,  reducing 
excessive  anxietv  and  emotiona 
tension.  In  so  doing,  Librium  in- 
directly  affects  cardiovasculai 
function. 

Librium  has  a  high  degree  o 
antianxiety  effectiveness  with  i 
wide  margin  of  safety.  In  propei 
dosage,  Librium  usually  helps  caln 
the  overanxious  patient  withou 
unduly  interfering  with  menta 
acuity  or  general  performance.  Ii 
the  elderlv  and  debilitated,  the  ini- 
tial dosage  is  5  mg  b.i.cl.  or  less  t< 
preclude  ataxia  or  oversedation,  in- 


: 


I 

4 


rreasing  gradually  as  needed  and 
oleratcd. 

Librium  is  used  concomitantly 
vith  certain  specific  medications  of 
)ther  classes  of  drugs,  such  as  car- 
liac  glycosides,  diuretics,  antihy- 
)ertensive  agents,  vasodilators  and 
inticoagulants.  Although  clinical 
tudies  have  not  established  a  cause 
ind  effect  relationship,  physicians 
hould  be  aware  that  variable  effects 
>n  blood  coagulation  have  been  re- 
ported very  rarely  in  patients  re- 
ceiving oral  anticoagulants  and 
ibrium.  After  anxiety  has  been 
educed  to  tolerable  levels,  Librium 
herapy  should  be  discontinued. 


5  mg 

For  geriatric 

patients  and, 

in  general,  for 

milder 

degrees  of 

clinically 

significant 

anxiety 


25  mg 
Specifically 
for  use  in 
severe  anxiety 


For  relief  of  excessive  anxiety 
adjunctive 

Librium:  10  mg 

(chlordiazepoxide  HC1)  ^^ 
lor2 capsules  t.i.d./q.i.d.   < R0CHE 


Before  prescribing,  please  consult  complete  product 
information,  a  summary  of  which  follows: 

Indications:  Relief  of  anxiety  and  tension  occurring 
alone  or  accompanying  various  disease  states. 

Contraindications:  Patients  with  known  hypersensi- 
tivity to  the  drug. 

Warnings:  Caution  patients  about  possible  com- 
bined effects  with  alcohol  and  other  CNS  depressants 
with  all  CNS-acting  drugs,  caution  patients  against  haz- 
ardous occupations  requiring  complete  mental  alertness 
(e.g.,  operating  machinery,  driving).  Though  physical  and 
psychological  dependence  have  rarely  been  reported  on 
recommended  doses,  use  caution  in  administering  to 
addiction-prone  individuals  or  those  who  might  increase 
dosage;  withdrawal  symptoms  (including  convulsions), 
following  discontinuation  of  the  drug  and  similar  to  those 
seen  witb  barbiturates,  have  been  reported.  Use  of  any 
drug  in  pregnancy,  lactation,  or  in  women  of  childbearing 
age  requires  that  its  potential  benefits  be  weighed  against 
its  possible  hazards. 

Precautions:    In  the  elderly  and  debilitated,  and  in 
children  over  six,  limit  to  smallest  effective  dosage  (ini- 
tially 10  nig  or  less  per  day)  to  preclude  ataxia  or  overse- 
dation,  increasing  gradually  as  needed  and  tolerated.  Not 
recommended  in  children  under  six.  Though  generally 
not  recommended,  if  combination  therapy  with  other  psy- 
chotropics seems  indicated,  carefully  consider  individual 
pharmacologic  effects,  particularly  in  use  of  potentiating 
drugs  such  as  MAO  inhibitors  and  phenothiazines.  Observe 
usual  precautions  in  presence  of  impaired  renal  or  hepatic 
function.  Paradoxical  reactions  (e.g.,  excitement,  stimula- 
tion and  acute  rage)  have  been  reported  in  psychiatric 
patients  and  hyperactive  aggressive  children.  Employ 
usual  precautions  in  treatment  of  anxiety  states  with  evi- 
dence of  impending  depression;  suicidal  tendencies  may 
be  present  and  protective  measures  necessary.  Variable 
effects  on  blood  coagulation  have  been  reported  very  rarel) 
in  patients  receiving  the  drug  and  oral  anticoagulants; 
causal  relationship  has  not  been  established  clinically. 

Adverse  Reactions:  Drowsiness,  ataxia  and  confusion 
may  occur,  especially  in  the  elderly  and  debilitated. 
These  are  reversible  in  most  instances  by  proper  dosage 
adjustment,  but  are  also  occasionally  observed  at  the 
lower  dosage  ranges.  In  a  few  instances  syncope  has  been 
reported.  Also  encountered  are  isolated  instances  of  skin 
eruptions,  edema,  minor  menstrual  irregularities,  nausea 
and  constipation,  extrapyramidal  symptoms,  increased 
and  decreased  libido— all  infrequent  and  generally  con- 
trolled with  dosage  reduction;  changes  in  EEG  patterns 
(low-voltage  fast  activity)  may  appear  during  and  after 
treatment;  blood  dyscrasias  (including  agranulocytosis i. 
jaundice  and  hepatic  dysfunction  have  been  reported 
occasionally,  making  periodic  blood  counts  and  liver  func- 
tion tests  advisable  during  protracted  therapy. 

Supplied:   Librium  ■  Capsules  containing  5  mg. 
10  mg  or  25  mg  chlordiazepoxide  IK  M.  Libritabs  K  Tablets 
containing  5  mg,  10  mgor  25  mg  chlordiazepoxide. 

_    Roche  Laboratories 
ROCHE   ?  Division  of  Hoffmann-La  Roche  Inc 
Nutley  New  Jersey  07110 


This  is  the  definitive  work  —  the 
most  comprehensive  reference  book 
to  date  of  the  diseases  of  the  inner  ear. 

It  is  based  upon  one  of  the  world's 
largest  collections  of  temporal  bone 
pathology.  There  are  700  illustra- 
tions: photographs  and  photomicro- 
graphs detail  the  natural  history  of 
ear  diseases;  views  of  gross  and  micro- 
scopic pathology  are  supplemented 
by  diagrams  and  drawings  of  anatom- 
ical points. 

A  work  of  inestimable  value,  it 


should  be  part  of  the  collection  of 
every  clinician,  surgeon,  and 
researcher  in  the  field. 

Dr.  Schuknecht  is  a  professor  at 
Harvard  Medical  School  and  Chief  of 
Otolaryngology  at  the  Massachusetts 
Eye  and  Ear  Infirmary.  $35.00 

A  magnificent  set  of  250  slides, 
corresponding  to  the  illustrations  in 
the  book,  is  also  available.  It  is  a  valu- 
able adjunct  to  the  Pathology  of  the 
Ear.  $210.00 


Commonwealth  Fund 

Harvard 

University 

Press 

Cambridge,  Mass.  02138 


Pathology 
of  the 
Ear 

Harold  F.  Schuknecht,  MD. 


Editor 

George  S.  Richardson  '46 

Managing  Editor 
Deborah  W.  Miller 


Editorial  Assistant 
Gwen  Frankfeldt 


Advertising  Agents 
John  Reeves  Associates,  Inc. 
345  Jaeger  Avenue 
Maywood,  N.J.  07607 

Steve  Ganak  Ad  Reps 
Statler  Office  Building 
Boston,  Mass.  02116 


Editorial  Board 

Robert  S.  Blacklow  '59;  Daniel  H. 
Funkenstein;  Tobin  N.  Gerhart  '75;  Samuel 
Z.  Goldhaber  76;  Robert  M.  Goldwyn  '56; 
Franz  J.  Ingelfinger  '36;  Jean  Mayer,  Ph.D.; 
Guillermo  C.  Sanchez  '49;  J.  Gordon 
Scannell  '40;  Prentiss  B.  Taylor,  Jr.,  '77. 

Association  Officers 

J.  Englebert  Dunphy  '33,  president;  William 
V.  McDermott  '42,  president-elect;  Claude 
E.  Welch  '32,  past-president;  Oglesby 
Paul  '42,  vice  president;  Franz  J. 
Ingelfinger  '36,  secretary;  Samuel  H. 
Kim  '62,  treasurer. 


Councilors 

A.  Clifford  Barger  '43A;  E.  Langdon 
Burwell  '44;  Nathan  S.  Davis  '47;  Daniel  D. 
Federman  '53;  Milton  W.  Hamolsky  '46; 
Eleanor  G.  Shore  '55;  William  W. 
Southmayd  '68;  Jesse  E.  Thompson  '43A; 
Catherine  M.  Wilfert  '62. 


Representative  to 
Associated  Harvard  Alumni 
Gordon  A.  Donaldson  '35 

Director  of  Alumni  Relations 
Perry  J.  Culver  '41 

Chairman  of  the  Alumni  Fund 
Carl  W.  Walter  '32 

The  Harvard  Medical  Alumni  Bulletin  is 
published  bi-monthly  at  25  Shattuck  St., 
Boston,  Mass.  021 15.  c  by  the  Harvard 
Medical  School  Alumni  Association.  Third 
class  postage  paid  at  Burlington,  Vermont. 


Credits:  pp.  8,  14,  16,  Stanley  A.  Newfield  '76; 
Cartoon  p.  10,  Ernest  Craige  '43A;  pp.  15,  28, 
David  J.  Levenson  76. 


Harvard  Medical 
Alumni  Bulletin 

September-October  1974 
Vol.  49 
No.  1 

SPECIAL  ISSUE:  Perspectives  on  the 

Harvard  Medical  School 

4  Overview 

Part  I  —  Introduction 

8  Getting  the  First  Word 
by  Samuel  Z.  Goldhaber 

9  The  Fundamental  Questions 
by  Andrew  R.  Hannas 

Part  II  —  Curriculum  Controversies 

12  The  Curriculum 

by  Steven  Z.  Glickel 

15  The  Clinical  Year  and  Beyond 

by  Martha  J.  Macdonald 

17  The  Harvard-MIT  Program  in 
Health  Sciences  and  Technology 
by  Kenneth  ft.  Bridges 

18  A  Non-Collective  View  of  the 
Biosocial  Curriculum 

by  Paul  S.  Appelbaum 

Part  III  —  Diversity 

21  Married  Students 
by  Mark  J.  Greenwald 

22  Women 

by  Maria  C.  Savoia 

23  Third  World  Students 
by  Juan  Montes 

26  Poor  Whites 

by  Harold  Bursztajn 

27  Native  Americans 
by  Janice  E.  Kulik 

Part  IV  —  Coping 

28  Dynamics  of  Student-Faculty  Interaction 
by  David  W.  Nierenberg 

30  The  Student-Liaison  Committee 
by  Leslie  M.  Greenberg 

31  Portrait  of  an  HMS  I 
by  Paul  C.  Shellito 

32  Marriage  to  a  Female  Medical  Student 
by  Bradley  E.  Alger 

33  A  View  from  the  Couch 
by  Samuel  Bojar,  M.D. 

38  Alumni  Notes 

42  Letters 

44  Death  Notices 

Cover:  A  photograph  of  Dr.  Samuel  Boiar,  psychiatrist  to  the 
Medical  Area  Health  Service,  counseling  an  HMSer  was 
rendered  in  airbrush  and  ink  by  Steven  Gildea  The  technique, 
photorealism,  uses  a  grid  placed  over  a  photograph,  which  is 
then  transposed,  square  by  square,  onto  the  canvas  Dr  Bojar  s 
contribution  to  Perspectives  on  the  Harvard  Medical  School  can 
be  found  on  p.  33 


Overview 


The  "Green  Book" 


The  Alumni  Survey  Committee,  as  its 
second  project,  has  begun  an  explora- 
tion of  student  life  and  attitudes  at  the 
Harvard  Medical  School.  One  of  the  ini- 
tial findings  was  a  feeling  on  the  part  of 
many  students  that  there  is  a  lack  of 
communication  between  the  faculty,  the 
administration  and  the  student  body. 
It  was  noted  that  the  last  official 
catalogue  of  the  Harvard  Medical 
School  was  issued  in  1967-1968.  This 
book,  as  well  as  previous  editions,  had 
a  green  cover. 

Within  the  last  few  months,  Mr.  Herbert 
Shaw  of  the  Harvard  Medical  News 
Office  published  an  informational  book- 
let of  the  Medical,  Dental  and  Public 
Health  Schools.  In  addition  to  some  60 
pages  of  general  description,  there  is 
an  annual  supplement  to  update  the  list- 
ings of  administrative  officers  and  fac- 
ulty and  to  provide  current  information 
about  the  curriculum  and  requirements 
for  admission.  This  booklet  has  been 
distributed  to  the  faculty,  but,  to  date, 
has  not  been  sent  to  applicants  for  ad- 
mission to  Harvard  Medical  School  or  to 
the  alumni. 

Last  spring,  with  the  intent  to  improve 
the  flow  of  information  about  life  and 
education  at  Harvard  Medical  School,  a 
number  of  concerned  students  wrote 
articles  about  aspects  of  particular  in- 
terest to  each  contributor.  This  enter- 
prise has  been  stimulated  and  coordi- 
nated by  Samuel  Z.  Goldhaber  76.  The 
product,  entitled  "Perspectives  on  the 
Harvard  Medical  School",  has  a  green 
cover  and  has  been  distributed  to  the 
members  of  the  new  first  year  class. 


In  response  to  the  expressed  desire  of 
many  alumni  to  learn  more  about  what 
Harvard  Medical  School  is  like  today, 
pertinent  articles  from  the  new  "Green 
Book'  are  published  in  this  issue  of  the 
Harvard  Medical  Alumni  Bulletin.  In 
reading  these  articles,  it  is  important  to 
remember  that,  with  the  heterogeneity 
of  today's  student  body,  there  is 
difficulty  in  reaching  consensus  on  al- 
most any  topic.  Each  article  represents 
an  individual  point  of  view  and  not 
necessarily  a  majority  opinion.  Extreme 
positions,  excessive  criticism,  as  well 
as  confusing,  rambling  and  sometimes 
downright  unintelligible  writing  are  part 
of  present  day  rhetoric  and  should  not 
be  a  cause  for  overreaction.  There  are 
comments  which  will  seem  unjustifiably 
critical  of  Harvard  Medical  School  to 
some  alumni  who  remember  it  more 
fondly.  Before  succumbing  to  irritated 
indignation,  one  must  recognize  that 
values  for  today's  students  have 
changed  in  many  ways.  A  medical 
school  can  no  longer  be  exclusively  in- 
volved in  the  pursuit  of  knowledge  and 
the  stimulation  of  students  to  learn. 
There  is  now  a  belief  that,  in  addition, 
medical  schools  have  an  obligation  to 
alleviate  social  injustice  and  to  improve 
the  health  care  of  neighboring  com- 
munities. As  consumers  of  education, 
students  take  the  position  that  they 
should  be  actively  involved  in  directing 
the  course  of  their  education  and 
should  have  a  voice  and  a  vote  in  mak- 
ing policy. 

The  need  to  formalize  a  system  of 
upper-class  advisors  for  first  year  stu- 
dents may  seem  incredible  to  those 
who  experienced  regular  contact  with 
members  of  other  classes  in  Vanderbilt 
Hall.  During  the  last  five  or  six  years, 


however,  the  student  body  has  grown 
from  just  over  500  to  680.  This  in- 
crease, together  with  the  fact  that  there 
are  many  more  married  students,  has 
changed  the  composition  of  Vanderbilt 
Hall  residency  almost  entirely  to  first 
year  students. 

The  indication  in  the  "Green  Book"  that 
an  adversary  situation  may  exist  be- 
tween students  and  faculty  is  disturb- 
ing. It  may  appall  those  alumni  who 
established  happy  and  often  enduring 
friendships  with  faculty  members  while 
at  HMS. 

During  this  coming  fall,  the  extent  of  an 
adversary  state  at  Harvard  Medical 
School  is  to  be  studied  in  depth  by  the 
Alumni  Survey  Committee.  It  and  the 
Alumni  Council  hope  to  see  an  early  re- 
turn to  better  communication  and  social 
relations  between  the  faculty  and  the 
students. 

There  are  articles  in  the  "Green  Book" 
that  are  comfortable  and  pleasant  to 
read.  The  Portrait  of  an  HMS  I  is  time- 
less. In  it,  one  can  detect,  already,  the 
seeds  of  happy  nostalgia  typical  of 
most  alumni.  Dr.  Samuel  Bojar's  under- 
standing and  sympathetic  description  of 
the  emotional  experiences  of  a  medical 
student  at  Harvard  is  reassuring. 

Establishment  of  a  Student  Liaison 
Committee  is  good  news  for  applicants, 
medical  students  and  alumni.  During 
the  last  year,  a  number  of  alumni  have 
offered  to  serve  as  preceptors  or  hosts 
for  Harvard  Medical  students.  With  a 
Student  Liaison  Committee,  it  will  be 
easier  to  bring  students  and  alumni  to- 
gether. 

Regardless  of  how  alumni  react  to  read- 
ing the  "Green  Book,"  they  owe  an  un- 
derstanding vote  of  thanks  to  these 
students  who  chose  to  present  their 
perceptions  of  Harvard  Medical  School. 
It  may  not  always  be  apparent,  but  they 
care  about  Harvard  and  seek  to  im- 
prove it.  There  is  a  strong  desire  for 
student  power  to  join  with  alumni  power 
to  make  Harvard  Medical  School  more 
nearly  equal  to  everyone's  expecta- 
tions. 

Perry  J.  Culver '41 


Alumni  Office  Reviews 
Offspring  Applicants 


Perry  J.  Culver,  '41,  Director  of  Alumni 
Relations,  is  anxious  to  follow  up  and 
promote  the  interests  of  alumni  sons, 
daughters,  and  grandchildren  who 
apply  to  HMS.  For  identification  pur- 
poses, each  alumnus(a)  whose  off- 
spring is  an  applicant  should  write  a 
letter  to  the  Director  of  Alumni  Rela- 
tions with  the  applicant's  name  and 
undergraduate  college  so  that  Dr. 
Culver  can  review  the  application  and 
work  with  the  Admissions  Committee. 


HMS  Votes  Departments 
of  Psychiatry 


Six  psychiatric  hospital  departments 
were  voted  to  be  established  by  the  ex- 
ecutive committee  of  the  department  of 
psychiatry,  Harvard  Medical  School. 
The  departments  and  their  elected  de- 
partment heads  are: 


Elvin  V.  Semrad,  M.D.,  professor  of 
psychiatry  —  acting  head,  department 
of  psychiatry  at  the  Massachusetts 
Mental  Health  Center,  including  the 
Peter  Bent  Brigham  Hospital, 
psychobiology,  and  the  Laboratory  of 
Community  Psychiatry;  Leon  Eisen- 
berg,  M.D.,  professor  of  psychiatry  — 
head  of  the  department  of  psychiatry  at 
the  Massachusetts  General  Hospital, 
including  the  Lindemann  Center,  and 
chairman  of  the  executive  committee  of 
the  department;  Shervert  H.  Frazier, 
Jr.,  M.D.,  professor  of  psychiatry  — 
head  of  department  of  psychiatry  at 
McLean  Hospital;  John  E.  Mack,  M.D., 
professor  of  psychiatry  —  head  of  the 
department  of  psychiatry  at  the  Cam- 
bridge Hospital,  including  Mt.  Auburn 
Hospital;  John  C.  Nemiah,  M.D.,  pro- 
fessor of  psychiatry  —  head  of  the  de- 
partment of  psychiatry  at  Beth  Israel 
Hospital;  and  Julius  B.  Richmond, 
M.D.,  professor  of  child  psychiatry  and 
human  development  —  head  of  the  de- 
partment of  psychiatry  at  the  Children's 
Hospital  Medical  Center. 


Ten  Reach 
Emeritus  Status 


Ten  members  of  the  faculty  of  medicine 
have  attained  emeritus  status.  Those 
honored,  and  their  titles  are: 

Bradford  Cannon,  M.D.,  clinical  pro- 
fessor of  surgery,  emeritus:  David  G. 
Cogan,  M.D.,  Henry  Willard  Williams 
professor  of  ophthalmology,  emeritus; 
A.  Stone  Freedberg,  M.D.,  professor 
of  medicine,  emeritus;  Luigi  Gorini, 
M.D.,  professor  of  microbiology  and 
molecular  genetics,  emeritus:  Roy  O. 
Greep,  M.D.,  professor  of  anatomy, 
emeritus;  Arthur  T.  Hertig,  M.D., 
Shattuck  professor  of  pathological 
anatomy,  emeritus;  Herman  M.  Kal- 
ckar,  M.D.,  professor  of  biological 
chemistry,  emeritus;  Harold  D.  Levine, 
M.D.,  clinical  professor  of  medicine, 
emeritus;  William  C.  Moloney,  M.D., 
professor  of  medicine  at  the  Peter  Bent 
Brigham  Hospital,  emeritus:  and 
Thomas  B.  Quigley,  M.D.,  clinical  pro- 
fessor of  surgery,  emeritus. 


PROMOTIONS 


Professor 

Chilton  Crane  '38:  surgery  at  Peter  Bent  Brigham  Hospital 
Roman  W.  DeSanctis  '55:  medicine  at  Massachusetts 

General  Hospital 
Walter  C.  Guralnick:  oral  surgery  at  MGH 
Sidney  H.  Ingbar  '47:  medicine 
H.  Richard  Tyler:  neurology  at  PBBH 
Emil  R.  Unanue:  immunopathology 


Associate  Professor 

Theodore  Colton:  preventive  and  social  medicine 

J.  Alan  Hobson  '59:  psychiatry 

Norman  Jaffee:  pediatrics  at  Children's  Cancer  Research 

Foundation 
Daniel  V.  Kimberg:  medicine 
Israel  Mirsky:  mathematical  biology  in  the  department  of 

medicine 
W.  John  Powell,  Jr.:  medicine  at  MGH 
J.  Stuart  Soeldner:  medicine  at  PBBH 
Stuart  F.  Schlossman:  medicine 
Stephen  F.  Vatner:  medicine 


Associate  Clinical  Professor 

C.  Grant  Champlin  Lafarge:  pediatrics 
Albert  L.  Sheffer:  medicine 


Assistant  Professor 

Herbert  T.  Abelson:  pediatrics 

Blanche  P.  Alter:  pediatrics 

Henry  G.  Altman:  psychiatry  at  Beth  Israel  Hospital 

Lenore  A.  Boling:  psychiatry  at  Massachusetts  Mental  Health 

Center 
Jan  L.  Breslow  '68:  pediatrics 
Richard  D.  Budson:  psychiatry  at  McLean  Hospital 
Joan  D.  Crain:  pediatrics  at  The  Children's  Hospital 
Robert  B.  Dornoff:  oral  surgery  at  MGH 
Carl  J.  D'Orsi:  radiology  at  PBBH 
Horst  S.  Filtzer  '65:  surgery  at  Cambridge  Hospital 
Thomas  O.  Fox:  neuropathology 
Michael  D.  Freed:  pediatrics  at  TCH 
Paul  A.  Friedman  '69:  clinical  pharmacology 
Richard  F.  Gibbs:  anaesthesia  at  Boston  Hospital  for  Women 
David  J.  Greenblatt  70:  medicine 
John  G.  Gunderson  '67:  psychiatry 
Robert  I.  Handin:  medicine  at  PBBH 
Stuart  T.  Hauser:  psychiatry  at  MMHC 


Edward  P.  Hoffer  '69:  medicine  at  MGH 

Philip  L.  Isenberg  '55:  psychiatry  at  MH 

Dennis  L.  Kasper:  medicine 

John  F.  Keane:  pediatrics  at  TCH 

Edwin  H.  Kolodny:  neurology  at  MGH 

Anthony  L.  Komaroff:  medicine  at  Bl 

Robert  S.  Lawrence  '64:  medicine  at  CH 

Emanual  Lebenthal:  pediatrics  at  TCH 

Vilas  V.  Likhite:  medicine 

Joseph  F.  Lipinski:  psychiatry  at  MGH 

Frederick  H.  Lovejoy,  Jr.:  pediatrics  at  TCH 

Samuel  E.  Lux  IV:  pediatrics 

Eric  Martz:  pathology 

Ronald  P.  McCaffrey:  Pediatrics 

Hubert  S.  Mickel  '62:  neurology  at  TCH 

Holim  Mitry:  psychiatry  at  MMHC 

Kenneth  K.  Nakano:  neurology  at  PBBH 

John  E.  O'Malley:  psychiatry  at  TCH 

Robertson  Parkman:  pediatrics 

Mark  A.  Peppercorn  '68:  medicine  at  Bl 

Siegried  M.  Pueschel:  pediatrics  at  TCH 

Bernard  A.  Rosner:  preventive  and  social  medicine 

Robert  H.  Rubin  '66:  medicine  at  MGH 

Charles  D.  Scher:  pediatrics 

Gino  V.  Serge:  medicine  at  MGH 

Harvey  B.  Simon  '67:  medicine  at  MGH 

Harold  S.  Solomon:  medicine  at  PBBH 

Reynold  Spector:  medicine 

Jocelyn  Spragg:  medicine  (immunology) 

James  Steinberg:  medicine  at  PBBH 

Myron  R.  Stocking:  psychiatry  at  MH 

Louis  E.  Teichholz  '66:  medicine  at  PBBH 

Demetrius  G.  Traggis:  pediatrics  at  CCRF 

Nancy  E.  Waxier:  sociology  in  the  department  of  psychiatry 

Gordon  C.  Weir  '67:  medicine  at  MGH 

H.  Lee  Weith:  medicine  (biochemistry) 

Jack  Wittenberg:  radiology  at  MGH 

Bryan  T.  Woods:  neurology  at  MH 


Assistant  Clinical  Professor 

C.  Cabell  Bailey:  medicine 

Harold  L.  Chandler:  medicine 

Paul  F.  Depaola:  dental  ecology 

George  H.  Gifford,  Jr.  '58:  surgery 

James  A.  Gregg:  medicine 

Charles  J.  Hatem  '66:  medicine 

Norbert  Hirshhorn:  medicine 

Carl  S.  Hoar,  Jr.  '45:  surgery 

Alan  L.  Kaitz  '53:  medicine 

Arthur  R.  Kravitz  '54:  psychiatry 

Walter  S.  Krawczyk:  oral  biology  and  pathophysiology 

Sumner  D.  Liebman  '38:  ophthalmology 

John  B.  Livingstone  '58:  psychiatry 

Doris  Menzer-Benaron:  psychiatry 

Donald  Ottenstein:  psychiatry 

Abraham  Pollen:  ophthalmology 

Louis  A.  Selverstone  '44:  medicine 

Judith  E.  Singer:  psychology  in  the  department  of  psychiatry 

Robert  H.  Talkov:  medicine 


Senior  Associate 

Philip  A.  Drinker:  surgery  (biomedical  engineering) 

Principle  Associate 

Barbara  B.  Farquhar:  computer  science 
James  W.  Poitras:  computer  science 


Principal  Research  Associate 

Julian  N.  Kanfer:  neuropathology  (biochemistry) 

APPOINTMENTS 

Professor 

Edward  R.  Epp:  radiation  therapy  at  MGH 


Associate  Professor 

Philip  R.  Larsen:  medicine  at  PBBH 
Sebastiano  Santostefano:  psychology  in  the  department  of 
psychiatry  at  MH 


Assistant  Professor 

Harvey  I.  Cantor:  medicine 
Martin  C.  Carey:  medicine 
Gregory  L.  Eastwood:  medicine  at  West  Roxbury  Veterans 

Administration  Hospital 
Lowell  E.  Schnipper:  medicine  at  Bl 


Principal  Research  Associate 

Franklin  A.  Sher:  pathology 


Sandoz  Pharmaceuticals  introduces 

A  FUTURE 

PHYSICIAN 
PROGRAM 

— providing  new  opportunities  for  students  to  enhance  their  medical  education. 


Features  of  the  program  include: 

□  teaching  films  available  on  a  loan  basis 

□  Sandoz  Annual  Achievement  Award 

□  guest  lecturer  programs 

□  educational  booklets 

□  audio-visual  aids  on  obesity,  psychiatric  emergencies,  geriatrics, 
and  other  subjects  of  medical  interest 

□  other  specialized  medical  services 

For  complete  information  about  the  FUTURE  PHYSICIAN 
PROGRAM  contact: 

John  Staffier, 

medical  school  Sandoz  representative 
for  the  New  England  Area 
100  College  Ave,  Medford,  Mass  02155. 
Telephone:  (617)  391-8545 

or  Don  Gunneson, 

Sandoz  Pharmaceuticals,  Route  10, 
East  Hanover,  NJ  07936. 
Telephone:  (201)  386-8394. 

John  Staffier 


Why 
Perspectives 


PERSPECTIVES  ON  THE  HARVARD  MEDICAL  SCHOOL 


Jtti*— 


Sp'.rv)  J*X)  S*xn*t9t  '9T4 


The  Cover 


When  alumni  return  to  Harvard  Medical  School,  the  prime  question  on  their  minds 
is:  "How  have  things  changed?"  They  sneak  into  Vanderbilt  Hall  to  see  if  their 
rooms  are  as  they  remember  them.  They  appoint  committees  such  as  the  Alumni 
Survey  Committee  to  examine  specific  changes  in  depth.  They  slap  Perry  Culver 
'41,  on  the  back  at  cocktail  parties  and  remind  him  to  defend  their  stake  in  the 
school,  which  is  too  often  either  undefined  completely  or  confined  to  assuring  their 
offspring's  admission.  And  there  are  even  some  alumni  who  override  their  natural 
shyness,  self-consciousness,  and  embarrassment  to  approach  undergraduates 
and  ask  them:  "What  are  things  like  at  Harvard  Medical  School,  these  days?" 

Every  student  who  answers  that  question  is  speaking  for  him  or  her  self.  An  indi- 
vidual might  be  involved  with  a  particular  cause  and  answer  the  alumn  us  (odds  are 
it's  a  non-poor  white  male)  from  that  individual  student's  perspective. 

Although  Perspectives  on  the  Harvard  Medical  School  was  put  together  primarily 
for  incoming  students,  it  can  serve  other  worthwhile  purposes.  Current  students 
can  learn  many  intricacies  about  HMS  that  they  never  dreamed  existed.  For  the 
editor,  now  a  third-year  medical  student,  this  has  been  an  extraordinary  learning 
experience.  But  alumni  can  also  benefit  from  having  a  diverse  group  of  students 
"tell  it  like  it  is."  The  original  version  is  divided  into  six  parts:  introduction,  curriculum 
controversies,  diversity,  coping,  Vanderbilt  Hall  and  the  local  scene,  and  conclu- 
sion. The  last  two  sections  have  been  omitted  from  the  Bulletin's  edition. 

George  S.  Richardson  '46,  Editor  of  the  Harvard  Medical  Alumni  Bulletin,  agreed 
that  alumni  could  benefit  from  reprinting  most  of  Perspectives.  /  want  to  extend  my 
thanks  to  him  and  to  the  new  Managing  Editor,  Deborah  W.  Miller. 

I  have  prefaced  each  article  with  explanatory  remarks  about  either  the  author 
and  lor  the  subject  matter.  These  brief  editorial  notes  appear  in  italics. 

Samuel  Z.  Goldhaber  76 


Part  I  -  Introduction 


Getting  the  First  Word 

by  Samuel  Z.  Goldhaber  '76 


The  Green  Book,  known  formally  as 
Perspectives  on  the  Harvard  Medical 
School,  is  mailed  to  incoming  first-year 
students  during  the  summer  calm,  while 
there  is  still  an  opportunity  to  relax 
and  philosophize  before  the  September 
storm.  It  serves  many  purposes, 
perhaps,  in  this  order  of  priority.  First, 
Perspectives  prods  you  to  ask  yourself 
what  going  to  medical  school  will  really 
mean,  not  just  in  terms  of  getting  a  de- 
gree but  in  the  sense  of  how  it  will  affect 
and  help  shape  your  life.  Sometimes  as 
students,  we  do  not  ask  ourselves  what 
medicine  is  all  about  until  the  week  we 
are  pressured  by  finals  in  biochemistry 
and  physiology.  Summer  is  a  good  time 
to  sit  back  and  think.  Second, 


Perspectives  introduces  you  to  the 
newest  "new  curriculum "  and  in  a 
series  of  articles,  outlines  a  variety  of 
viewpoints  on  medical  education.  No 
one  person  could  possibly  agree  with 
all  the  viewpoints,  simply  because  they 
conflict.  But  familiarizing  yourself  with 
different  arguments  about  medical  edu- 
cation is  a  goal  worth  striving  for.  This 
familiarity  will  lead  to  a  greater  under- 
standing of  the  pros  and  cons  of  your 
curriculum.  Third,  Perspectives  recog- 
nizes the  diversity  of  incoming  students 
and  hopes  that  with  diversified  articles, 
students  will  gain  a  better  idea  of  what 
lies  in  store  for  them  at  Harvard  Medical 
School  (HMS)  and  will  become  more 
sensitive  to  each  other. 


Fourth,  Perspectives  wants  you  to  rec- 
ognize right  now  that  HMS  is  not  an 
ideal  world,  and  that  it  has  problems 
just  like  any  other  institution.  We  feel  that 
at  times,  students  have  such  high  expec- 
tations of  this  school  that  it  would  not  be 
humanly  possible  to  meet  them. 
Through  different  articles,  we  explore 
the  positive  and  negative  aspects  of 
student  interactions  and  face  squarely 
the  fact  that  coping  at  HMS  is  some- 
thing that  must  be  worked  for.  One 
cannot  adjust  effortlessly. 

You  might  be  curious  about  the  history 
of  the  Green  Book.  It  helps  fill  a  void 
which  began  in  1967,  when  the  Medical 
School  published  its  last  catalog.  Right 


8 


now,  the  News  Office  has  just  pub- 
lished a  new  catalog.  But  consider  the 
anxiety  of  applying  to  a  school  and 
being  accepted,  and  yet  not  having  the 
benefit  of  an  information  booklet.  Dur- 
ing the  1969-1 970  academic  year, 
three  students  in  the  Class  of  1 973  de- 
cided to  try  to  provide  incoming  stu- 
dents with  at  least  some  information. 
The  Administration  provided  money  for 
an  unofficial  publication  which  was 
called  "An  Introduction  to  Harvard  Med- 
ical School."  It  was  36  pages  long, 
pocket-sized,  and  like  a  multitude  of 
other  Harvard  University  publications, 
had  a  red  cover.  It  was  soon  known  as 
"the  Red  Book."  In  1972,  John  Eich- 
horn  73,  one  of  its  three  founders,  up- 
dated and  reissued  it. 

The  Red  Book  reflected  the  empathy  of 
HMSers  for  incoming  students.  But  by 
the  time  of  Class  of  1 976  received  the 
Red  Book,  it  was  outdated.  The  Red 
Book  seemed  anachronistic  because  it 
failed  to  address  itself  sufficiently  to  the 
concerns  of  married  students,  women, 
third  world  students,  and  poor  whites. 

In  setting  up  the  format  for 
Perspectives,  some  argued  that  we 
should  portray  HMS  as  a  happy  place 
where  there  is  a  lot  of  togetherness  — 
that  we  should  talk  only  about  the  posi- 
tive and  ignore  the  negative.  We  dis- 
agreed with  this  approach  and  believed 
that  those  entering  graduate  school 
should  be  dealt  with  in  an  intellectually 
honest  way.  We  encouraged  individu- 
als to  express  opinions  and  solicited  a 
broad  spectrum.  We  wanted  the  Green 
Book  to  be  controversial  but  as  bal- 
anced as  possible. 

Before  you  read  the  rest  of  the  Green 
Book,  we  want  to  caution  you  that 
Perspectives,  even  with  its  1 7  articles, 
is  incomplete.  Topics  not  discussed  in- 
clude tuition,  financial  aid,  part-time  job 
and  research  opportunities,  joint  de- 
gree programs  with  the  School  of  Public 
Health  and  the  Kennedy  School  of 
Government,  and  clinical  rotations  at 
other  medical  schools  both  within  and 
outside  the  United  States. 

The  other  warning  is  that  this  is  a  collec- 
tion of  articles  written  by  1 7  people. 
There  is  no  pretense  that  any  individual 
author  is  speaking  for  a  particular  group 
he  or  she  is  writing  about.  The  articles 
are  not  a  collection  of  Harris  polls,  but  a 
combination  of  facts  with  reasonable 


people's  personal  opinions.  Reading 
the  Green  Book  is  not  a  substitute  for 
speaking  to  a  variety  of  upperclassmen, 
faculty,  and  administrators  when  you 
arrive  at  HMS. 

Finally,  we  want  to  give  special  thanks 
to  three  individuals.  Frederick  C.  Lane, 
Dean  of  Students,  provided  the  initial 
encouragement  for  this  project.  Herbert 
A.  Shaw,  Director  of  Medical  Informa- 
tion in  the  University  News  Office, 
ushered  the  Green  Book  from  its  un- 
typed form  to  the  finished  product.  And 
last,  Marvin  J.  Bittner  76,  has  devoted 
an  inordinate  amount  of  time  to  the 
Green  Book.  He  helped  edit  the  articles 
written  by  the  editor  and  provided  help- 
ful ideas  and  encouragement. 


Psychiatrist  James  A.  Knight,  author  of 
Medical  Student:  Doctor  in  the 
Making  (New  York:  Appleton-Century- 
Crofts,  1973).  wrote: 

"Students  are  often  told  on  the  day  of  en- 
tering medical  school  that  when  the  sun 
goes  down,  they  will  be  far  behind  in 
their  work  and  will  never  catch  up  in 
their  lifetime.  When  the  day  ends,  stu- 
dents are  convinced  that  the  prophecy 
has  begun  to  unfold.  The  wise  ones  de- 
velop an  existential  stance  and  try  to 
live  fully  each  day,  for  today  is  all  they 
have  for  certain.  When  tomorrow 
comes,  it  will  bring  a  new  set  of  de- 
mands and  will  permit  the  consideration 
of  very  little  of  that  which  was  unwisely 
put  off  from  yesterday. 


The  Fundamental  Questions 


by  Andrew  R.  Hannas  '76 


Some  alumni  will  not  understand  this  article.  Andrew  R.  Hannas  76  (some  of  you 
may  be  acquainted  with  the  dynamic  R.  R.  Hannas  '50)  takes  a  philosophical  ap- 
proach to  the  most  basic  questions  of  student  existence  at  medical  school.  His 
complex  article  should  be  read  slowly,  as  a  postprandial  activity.  Perhaps  it  can 
only  be  appreciated  by  those  who  have  been  asked  literally  hundreds  of  times: 
"Why  go  to  medical  school?''  Those  who  never  considered  the  alternatives  may 
also  fail  to  grasp  the  significance  of  what  the  younger  Hannas  is  saying. 


What  will  it  be  like  at  Harvard  Medical 
School?  At  various  times  and  in  various 
places,  you  may  come  across  the  typi- 
cally empty  descriptions:  "Harvard 
Medical  School  is  such  a  fathomless, 
intangible  entity  that  no  single  stroke  or 
cluster  of  images  can  adequately  por- 
tray its  essence."  Or:  "Students  at  Har- 
vard Medical  School  are  highly  intellec- 
tual and  individualistic,  with  such  di- 
verse talents  and  interests  that 
generalizations  about  the  school  are 
impossible."  While  it  is  mundanely  ac- 
curate to  say  that  the  HMS  experience 
will  be  an  "individual"  one,  it  is  perhaps 
less  obvious  that  the  experience  will  nor 
be  an  "intellectual"  one.  Indeed,  de- 
spite an  overt  and  probably  genuine  ef- 
fort to  appeal  to  one's  rationality  or  intel- 
lect, HMS  will  exert  its  greatest  effect 
emotionally.  This  is  not  emotion  in  the 
sense  of  "pride"  or  of  "feeling  good" 
about  being  a  member  of  an  "intellec- 


tual community.    If  anything,  it  is  the 
opposite. 

It  is  the  feeling  of  frustration  at  being  a 
member  of  a  community  whose  mem- 
bers are  unsure  of  their  goals,  refuse  to 
espouse  a  common  goal,  and  answer 
the  student's  questions  by  urging.  "De- 
velop your  own  interests."  It  is  the  feel- 
ing of  being  antagonized  (or  humili- 
ated) in  the  classroom  and  hospital 
situation  by  someone  who  was  an- 
tagonized long  ago  (or  not  so  long  ago) 
It  is  the  feeling  of  infuriation  at  the  way 
many  people  behave  at  times  around 
HMS.  It  is  the  feeling  of  cynicism  that 
runs  deep  in  Amphitheatres  C  and  E, 
especially  up  in  the  back  rows  and  over 
in  corners.  A  healthy  cynicism  — 
maybe  some  see  it  more  as  skepticism 
—  will  smooth  over  many  otherwise  in- 
tolerable (intellectually,  emotionally, 
sexually,  racially)  statements  made 


with  emphasis,  sincerity,  proper  accent, 
wit,  and  appropriate  diction  and  syntax 
at  the  bottom  of  those  amphitheatres  by 
authorities  all  of  whom  are  experts  in 
their  fields  and  most  of  whom  are  "intel- 
lectuals.' The  cynicism  also  will  touch 
off  that  roving,  jaundiced  eye  during  the 
occasional  lag  in  the  excitement  of  the 
amphitheatre  stage.  "Isn't  this  a  weird 
place?  Aren't  these  people  really 
strange?  How  in  the  world  will  I  ever 
become  a  doctor?  Why  am  I  here?"  As 
the  months  pass,  the  questions  be- 
come louder;  their  content,  proportion- 
ately monosyllabic. 

In  short,  peace  of  mind  will  not  be  found 
at  HMS.  Nor  will  one  find  a  day-to-day 
routine,  8-to-5,  railroad-track  approach 
to  "turning  out  doctors  as  fast  and  as 
efficiently  as  possible  in  order  to  meet 
the  needs  of  the  people  and  the  health 
care  system."  It  has  been  said  that  doc- 
tors are  trained,  not  educated.  Well, 
HMS  refuses  to  train  and  expects  one 
already  to  have  been  educated.  Again, 
the  burden  is  on  the  individual  to  define 
his  approach  to  his  HMS  experience.  In 
this  respect,  one  will  not  find  someone 
at  HMS  saying  what  a  student  should  or 
should  not  do.  As  in  most  academic  en- 
vironments, freedom  and  guidance  will 
often  seem  mutually  exclusive. 

Because  almost  every  student  formu- 
lates an  intensely  personal  expression 
of  the  reasons  for  going  into  medicine, 
the  individualistic  atmosphere  encoun- 
tered at  HMS  is  initially  rather  refresh- 
ing. After  the  newness  wears  off,  how- 
ever, those  intricate,  well  rehearsed 
phrases  that  could  hypnotize  relatives 
and  dazzle  admission  committees 
begin  to  gather  dust  in  that  special  part 
of  the  cerebrum  that  got  high  grades, 
high  MCAT  scores,  and  good  letters  of 
recommendation.  Some  students  will 
have  remarkable  recall  of  these 
reasons,  as  if  they  were  on  permanent 
loan  from  a  record  library.  But  usually 
the  neatly-bound  package  of  reasons 
and  sub-reasons  for  wanting  to  come  to 
HMS  becomes  displaced  by  the  more 
primitive  "Why  am  I  here?",  necessitat- 
ing complete  reassessment  and  refor- 
mulation of  attitudes  and  aspirations. 
Although  deceptively  simplistic,  the 
question  in  its  broadest  sense  should 
confront  every  student  virtually  every 
day  he  or  she  attends  HMS.  Otherwise, 
the  student  is  not  being  critical  enough. 
Similarly,  every  student  should  answer 
this  question  (satisfactorily  or  unsatis- 


factorily), for  not  to  do  so  will  necessi- 
tate insulation  if  not  isolation  from  the 
medical  community.  Such  an  answer 
will  represent  the  student's  rationaliza- 
tion, justification,  or  "philosophy"  be- 
hind the  steps  he  or  she  has  taken  in 
medical  school  or  is  about  to  take  fol- 
lowing medical  school.  The  "answer" 
should  not  come  so  easily  and  quickly 
that  a  student's  horizon  is  narrowed. 
There  is  enough  time  at  HMS  to  sort  life 
out  tentatively  —  and  an  astounding 
number  of  paths  to  explore  along  the 
way  —  if  one  consciously  works  at  it.  If 
not,  the  forces  at  work  behind  the 
scenes  in  the  medical  community  can 
drag  one  along,  tossing  out  bits  of 
cheese,  glasses  of  sherry,  boxes  of 
cigars,  and  bottles  of  beer  (as  well  as 
an  occasional  polished,  inspirational 
lecture),  subtly  channeling  one  into  at- 
titudes and  directions  which  the  student 
thinks  are  self-chosen  but  which  never 
really  answer  that  question.  "Why  am  I 
here?"  The  cheese  can  be  eaten  and 
the  beer  drunk  without  falling  into  the 
trap,  but  watch  out  for  the  sherry. 

So.  why  is  one  here?  The  germinal  re- 
sponses seem  to  express  two  ideas:  "I 
am  here  because  (I  think)  I  want  to  be- 
come a  doctor"  or  "I  am  here  because 
(I  think)  I  have  no  better  alternative.   To 
further  distill  these  two  responses:  "I 
am  here  because  (I  think)  I  want  to  be 
here   or  "I  am  here  because  (I  think)  I 
don't  want  to  be  anywhere  else."  The 
"(I  think)"  is  in  each  case  the  student  s 
safety  valve.  It  will  goad,  but  it  will  allow 


release  when  the  question  "Why  am  I 
here? "  threatens  to  strangle  even  the 
most  acceptable  stage  of  answer  a  stu- 
dent (thinks  he  or  she)  has  developed. 
The  thoughts  that  follow  are  not  in- 
tended to  make  answering  the  question 
any  easier.  They  are  meant  to  serve 
primarily  as  a  warning  to  those  who  will 
try  not  to  answer  the  question  (or  in- 
deed, to  try  not  to  ask  it).  Their  own 
deference  will  pose  the  greatest  danger 
they  will  face  at  HMS.  Secondarily, 
these  thoughts  are  intended  to  serv^as 
a  suggestion  to  those  who  will  respond 
initially  by  saying  they  are  here  be- 
cause of  no  better  alternative.  Their 
negativism  will  signal  the  greatest  need 
for  their  continual  re-examination  and 
reconsideration  of  why  they  are  in  med- 
ical school. 

From  time  to  time,  appropriate  person- 
ages will  remind  students  that  after  four 
years  of  basic  sciences,  clinical  rota- 
tions, and  National  Board  exams,  the 
M.D.  degree  is  attained.  Consequently, 
one  is  reminded,  it  is  important  if  not 
imperative  to  keep  this  goal  in  sight,  to 
keep  things  in  perspective.  The  title  — 
Medicinae  Doctor  —  represents,  one 
hears,  the  individual  efforts  of  four 
years,  the  collective  efforts  of  hundreds 
of  students  and  faculty,  and  the  backing 
of  hundreds  of  thousands  of  dollars. 
Implicit  in  these  attitudes,  or  derived 
from  them,  are  the  notions  (1 )  that  four 
years  of  individual  efforts  have  been 
fruitful  and  deserve  recognition;  (2)  that 
students  and  faculty  have  been  united 
in  such  efforts:  and  (3)  that  the  degree, 
itself  priceless,  is  a  virtual  blank  check 
for  its  owner.  The  voice  representing 
the  first  attitude  is  usually  the  student's; 
that  representing  the  second,  the 
Dean  s:  that  of  the  third,  an  insurance 
salesman's. 

Such  attitudes  are  not  without  truth,  nor 
are  they  incompatible  with  whatever 
paths  a  student  explores.  Where  they 
do  obscure  or  distort  the  actual  reality 
of  the  four-year  experience  and  the  po- 
tential reality  of  the  years  ahead  is  in 
their  consideration  of  the  degree  as  a 
goal,  something  good  in  itself,  even  if 
immediate.  The  goal  of  getting  into 
medical  school  is  not  to  be  equated  with 
the  practicality  of  getting  through  medi- 
cal school.  The  intrinsic  value  of  the 
M.D.  degree  is  the  same  as  the  intrinsic 
value  of  four  years  of  medical  school, 
but  this  value  is  not  the  same  as  four 
years  of  secondary  education  and  a  di- 


10 


ploma,  followed  by  four  years  of  college 
and  a  Bachelor's  degree,  followed  by 
the  Master's,  Ph.D.,  etc.  Medical 
School  is  not  just  another  in  a  progres- 
sion of  academic  or  quasi-professional 
plateaus  in  a  student's  life,  to  be  fol- 
lowed by  its  own  endless  procession  of 
appointments,  each  with  its  special  re- 
ward or  "goal."  If,  however,  the  student 
chooses  (or  lets  others  choose),  he  or 
she  may  consider  the  degree  in  this  re- 
spect, in  which  case  its  value  does  in- 
deed lie  in  its  status  as  a  goal,  a  plum  to 
be  kept  in  sight  and  devoured  when 
ripe.  And,  conveniently,  HMS  will  roll 
out  the  carpet  for  those  who  pursue  this 
course.  Partly  for  self-glorification  but 
mostly  for  self-preservation,  HMS  will 
attempt  to  lure  ("to  recognize  academic 
excellence")  students  into  making  sure 
they  heed  the  voices,  that  they  do  in 
fact  keep  things  in  perspective. 

Alternatively,  the  student  can  attempt  to 
get  off  this  conveniently  automated 
treadmill.  The  medical  school  experi- 
ence should  be  the  substance  of  such 
an  exit,  and  the  M.D.  degree  should 
symbolize  it.  In  this  way  their  intrinsic 
value  derives  not  from  the  knowledge 
they  represent  but  from  the  object  of 
that  knowledge:  the  skill  to  help  people, 
especially  sick  people.  And,  as  far  as 
goals  are  concerned,  it  is  the  object  of 
the  knowledge  of  four  years,  not  the 
symbol  of  the  knowledge,  that  the  stu- 
dents should  keep  in  sight,  in  perspec- 
tive, and  it  is  the  form  of  the  object  that 
will  be  the  career  —  the  "answer"  — 
the  student  chooses.  Again,  the  ques- 
tion must  be  asked  daily,  and  the  an- 
swers explored  actively. 

Why  put  so  much  emphasis  on  a  de- 
gree which  no  student  really  worries 
about  anyway?  The  reason  is  simple: 
the  M.D.  degree  is  the  central  concept 
around  which  pivots  the  triad  of  (1 ) 
medical  knowledge;  (2)  the  object  of 
that  knowledge  (skills);  (3)  the  form  of 
that  object  (a  career).  A  student's  at- 
titudes toward  the  degree  and  toward 
the  four  years  themselves  will  condition 
if  not  determine  these  very  three  things, 
the  student's  knowledge,  skills,  and 
career,  both  immediately  and  ulti- 
mately. Were  these  of  no  consequence 
to  anyone  but  the  student  —  if,  for  ex- 
ample, no  one  except  the  student  cared 
whether  he  or  she  pursued  a  career  in 
public  health,  cancer  research, 
neurosurgery,  or  internal  medicine  — 
attitudes  during  medical  school  would 


not  matter  quite  as  much,  especially  if 
such  attitudes  are  fundamentally  sin- 
cere. Once  upon  a  time,  the  career  an 
HMS  student  chose  was  not  really  im- 
portant, as  long  as  personal  interests 
were  being  developed  along  the  way. 
The  form  of  the  object  (a  career)  was 
less  important  that  the  object  (skills) 
and  far  less  important  than  the  medical 
knowledge  itself. 

Unfortunately,  this  is  not  the  case 
today.  The  urgency  to  make  decisions, 
to  develop  appropriate  careers  as  well 
as  attitudes,  renders  the  development 
of  attitudes  a  great  responsibility.  Such 
urgency  stems  neither  from  the  needs 
of  the  HMS  community  nor  from  those 
of  the  nationwide  medical  community 
but  from  the  needs  of  society  itself. 
This,  too,  sounds  passe  nowadays,  but 
the  needs  of  people,  especially  sick 
people,  are  such  that  a  student  can  no 
longer  choose  a  career  on  the  basis  of 
interest  or  talent  alone.  And  HMS,  and 
its  myriad  opportunities,  does  little  to 
help  the  student  discriminate  (either  in- 
directly in  terms  of  curriculum  or  directly 
in  terms  of  counseling)  with  regard  to 
medical  knowledge,  skills,  or  career  op- 
tions. HMS  would  rather  have  students 
arrive  by  a  strange  and  inefficient,  if  not 
ineffectual,  combination  of  personal  in- 
terest, random  choice  (or  non-choice), 
and  positive  reinforcement  at  a  career 
(the  form )  which  may  or  may  not  be 
serving  the  object  of  the  knowledge 
(the  skills  to  help  society)  in  a  worth- 
while manner.  This  is  not  to  say  that 
society  does  not  need  all  types  of  doc- 
tors or  to  endorse  community  medicine 
over  research.  Wis  a  statement  that 
society's  problems  should  influence 
strongly  a  student's  particular  field  of 
basic  science  research  or  public  health. 

Indeed,  one  cannot  make  the  assump- 
tion that  there  is  any  fundamental  dif- 
ference in  outlook  within  any  of  the  var- 
ious spheres  of  interest  at  HMS.  To 
single  out  any  as  "at  fault"  would  be  not 
only  inaccurate  but  also  naive,  for  one 
need  only  pose  the  following  question 
to  see  that  all  of  HMS  has  a  stake  in 
shielding  its  students  from  too  strong  an 
influence  from  outside  forces:  if  people 
didn't  get  sick,  doctors  would  be  out  of 
work,  right?  Wrong!  The  medical  pro- 
fession, particularly  HMS,  is  self- 
perpetuating  because  disease  is 
defined  currently  by  doctors,  not  by 
those  who  are  ill.  This  applies  both  to 
research  and  to  clinical  medicine.  Ex- 


tending the  notion  of  self-perpetuation, 
one  can  see  why  HMS  would  be  reluc- 
tant to  guide  students  into  roles  that 
HMS  has  not  defined.  If  nothing  else, 
the  powers  that  be  at  HMS  donor  show 
suicidal  tendencies. 

If.  then.  HMS  will  not  guide  students 
into  those  roles  which  are  being  more 
and  more  dictated  by  society  and  not  by 
the  medical  profession,  who  will?  Soci- 
ety could,  but  to  the  student  in  the 
academic  environment,  where  is  soci- 
ety? In  Vanderbilt  Hall's  dining  room?  In 
the  Amphitheatres?  In  Building  A?  The 
individual  student  is  once  again  the 
answer,  although  this  time  by  default. 
HMS, by  giving  students  so  much  free- 
dom, by  flattering  their  "individuality,    is 
avoiding  cleverly  the  great  responsibil- 
ity of  guiding  students  into  those  roles 
whose  existence  society  defines  and 
demands.  With  the  responsibility  for 
carrying  out  this  task  on  his  or  her 
shoulders,  is  it  any  wonder  that  it  is  in- 
adequate for  a  student  to  rest  content 
saying,  "I  am  here  because  I  have  no 
better  alternative  "?  Is  it  so  strange  that 
a  student  can  no  longer  choose  any 
field  that  interests  him  or  her  without 
first  considering  the  impact  of  this 
choice  upon  society's  needs?  Is  it  so 
difficult  to  understand  why  attitudes 
toward  the  M.D.  degree  and  toward  four 
years  of  medical  school  are  so  crucial? 

With  active  exploration  of  these  kinds  of 
problems,  the  student  can  answer 
"Why  am  I  here?"  with  a  career  that  is 
in  harmony  with  personal  interests,  the 
medical  community,  and,  most  impor- 
tantly, the  needs  of  society.  This  explo- 
ration can  be  fun,  exciting,  and  at  times 
even  inspirational.  Undoubtedly  it  is  in 
wrestling  with  these  forces  that  the 
Harvard  Medical  School  experience 
becomes  for  each  student  more  emo- 
tional than  intellectual. 


11 


Part  II  -  Curriculum  Controversies 


The  Curriculum 

by  Steven  Z.  Glickel  '76 


It's  almost  impossible  to  keep  up  with  the  curriculum  changes  at  Harvard  Medical 
School.  Most  alumni  had  the  standard  two  years  of  basic  science,  which  except  for 
a  semester  of  pathophysiology  was  taught  on  a  departmental  basis  —  such  as 
biochemistry,  physiology,  and  microbiology.  Then  in  1968,  the  new  "core  cur- 
riculum" was  ushered  in,  with  one  and  one-half  years  of  basic  science  taught  inter- 
departmentally by  organ  systems  — such  as  cardiovascular,  respiratory,  and  renal. 
Now  in  1974,  the  curriculum  changes  once  again,  to  simulate  much  of  the  pre- 1 968 
one.  The  new  "new"  curriculum  has  almost  two  years  of  basic  science,  mostly 
taught  on  a  department  basis.  Steven  Z.  Glickel  '76,  class  representative  to  the 
Curriculum  Committee,  explains  the  details  of  the  newest  curriculum. 


I  have  the  dubious  distinction  of  inform- 
ing your  class  of  a  curriculum  about 
which  I  know  something,  many  faculty 
know  less,  and  most  students  know  vir- 
tually nothing.  The  sole  source  of  my 
familiarity  with  this  subject  is  member- 
ship on  the  HMS  Curriculum  Commit- 
tee, which  formulated  and  will  begin  to 
implement  this  new  course  of  study. 
Due  to  its  newness,  there  is  considera- 
ble confusion  and  circulating  misinfor- 
mation, some  of  which  I  can  hopefully 
dispel  and  none  of  which  I  will  inten- 
tionally propagate.  Bear  in  mind,  how- 
ever, that  my  interpretation  is  fallible 
and  that  this  is  not  the  definitive  state- 
ment on  your  curriculum.  If,  when  you 
arrive  in  the  fall,  you  encounter  some 
scheduling  problems,  going  to  the  Reg- 
istrar and  claiming  that  "Glickel  said  so" 
will  get  neither  of  us  very  far.  With  this 
preface  of  equivocation,  I  proceed. 

The  current  curriculum  which  began  in 
1 968  will  continue  for  the  classes 
ahead  of  you.  For  many  reasons,  it  is 
considered  deficient;  hopefully,  recent 
revisions  will  eliminate  some  of  those 
deficiencies  for  future  classes. 

Generally,  the  curriculum  can  be  di- 
vided into  preclinical  and  clinical  seg- 
ments with  some  overlap  between  the 
two.  The  preclinical  period,  for  the  great 
majority  of  students,  will  involve  the  first 


three  semesters  on  a  full-time  basis 
and,  during  the  fourth  semester,  will  be 
mixed  with  clinical  work.  The  clinical 
period  will  begin  in  the  fourth  semester 
and  continue  until  graduation.  Three 
half  courses  (see  below)  of  non-clinical 
electives  will  be  required  of  all  students 
during  the  clinical  period. 

A  modified  semester  system  will  be  in 
effect.  Semesters  will  last  approxi- 
mately four  months,  from  September 
through  December  and  from  February 
through  May,  with  January  and  June 
set  aside  as  blocks  of  time  for  reading, 
electives,  or  vacation.  Particular  re- 
quirements will  be  dealt  with  later  but  I 
should  mention  here  that  a  minimum  of 
1 32  credits  is  required  for  graduation 
and  the  amount  of  vacation  time  may 
depend  upon  how  you  distribute  your 
credits.  The  average  student  will  have 
four  weeks  spread  over  winter,  spring, 
and  Labor  Day  vacations,  and  one  addi- 
tional month  per  year. 

The  distinction  between  longitudinal 
and  block  courses  is  that  the  former  are 
taught  during  an  entire  semester  for 
several  hours  per  day  for  one  to  three 
days  a  week,  and  the  latter  for  two  or 
three  times  as  many  hours  per  day,  five 
or  usually  six  days  a  week.  Either  way 
Saturday  morning  classes  are  unavoid- 
able. Block  courses  are  customarily 


taught  as  single  subjects  during  multi- 
ples of  one  month  periods.  A  one  month 
block  is  equivalent  in  terms  of  credits  to 
a  four  month  longitudinal  course.  By 
way  of  clarification,  all  courses  are 
weighted  as  half,  quarter,  or  eighth 
courses  with  four,  two  or  one  credit  at- 
tributed, respectively,  to  each.  A  half 
course  is  officially  defined:  (1 )  for  lon- 
gitudinal courses  as  "an  approved 
course  requiring  a  minimum  often 
hours  per  week  of  classroom  and  out- 
of-class  time  over  a  full  semester"  and 
(2)  for  block  courses  "...  requiring  a 
minimum  of  40  hours  per  week  of  stu- 
dent time  over  a  period  of  four  weeks." 
Quarter  and  eighth  are  the  appropriate 
fractions  thereof. 

One  of  the  outstanding  features  of  this 
curriculum  is  its  flexibility.  Depending 
upon  past  experience  and  current  pref- 
erences, students  along  with  their  ad- 
visors will  design  individualized 
schedules  which  can  follow  any  one  of 
many  yet  unspecified  permutations.  All 
paths,  however  divergent,  lead  to  the 
M.D.  More  specifically,  the  courses  in 
the  first  year  will  generally  be  "basic 
science"  in  orientation  sponsored  by 
basic  science  departments  presumably 
with  input  from  the  clinical  faculty.  Each 
student  will  be  required  to  take  seven 
half-courses  in  basic  science  which  in- 
clude areas  such  as  biochemistry,  his- 


12 


tology,  neural  science,  physiology, 
anatomy,  pathology,  immunology  and 
pharmacology.  Exactly  when  each  par- 
ticular course  will  be  offered  and  how 
many  courses  might  be  offered  in  one 
general  area  are  undefined  thus  far.  If, 
for  example,  an  acceptable  course  is  in 
fall  and  spring  semesters  of  the  first 
year,  you  and  your  advisor  will  decide 
when  you  take  it. 

You  will  also  be  required  to  take  five 
half-courses  in  pathophysiology  and 
one  approved  quarter-course  in  social 
science  and  one  in  behavioral  science. 
Pathophysiology  courses  are  organized 
according  to  organ  systems  and  will 
represent  the  combined  efforts  of  basic 
scientists  and  clinicians  to  correlate 
morphological  and  functional  with  clini- 
cal changes  in  disease.  Pathophysiol- 
ogy courses  will  be  taught  in  fall  or 
spring  semesters,  thus  allowing  stu- 
dents to  begin  pathophysiology  in  the 
second  semester.  Presumably  social 
and  behavioral  science  courses  will  be 
available  both  as  longitudinal  courses 
during  the  four  month  semester  and  as 
one  month  block  courses  during 
January/June  periods. 

Most  students  will  take  four  half-course 
equivalents  in  each  of  the  first  two 
semesters.  The  ambitious  or  well  pre- 
pared student  can  take  five  courses. 
The  less  well  prepared  student  can  take 
three  courses  and  make  up  the  deficit 
at  a  future  time.  It  should  be  em- 
phasized that  such  time  will  exist;  if  you 
are  worried  about  your  ability  to  handle 
the  work  load,  rest  a  bit  easier  because 
you  can  go  at  a  slower  pace. 

Students  are  eligible  for  advanced 
standing  based  upon  previous  course 
work  or  demonstrable  competence  in 
an  academic  area.  Advanced  standing 
can  be  obtained  by  applying  to  the  Ad- 
missions Committee  before  you  begin 
class  or  to  the  respective  department 
before  or  after  arrival  at  Harvard. 
Heretofore,  placement  examinations 
have  been  given  during  the  orientation 
week  and  presumably  a  reasonable 
facsimile  will  be  retained. 

During  the  fourth  semester,  February 
through  May  of  the  second  year,  you 
will  be  expected  to  take  two  courses 
from  any  of  the  following:  basic  science, 
pathophysiology,  social  and  behavioral 
science,  or  any  appropriate  elective  if 
you  have  already  completed  the  re- 


quirements due  to  advance  standing 
and/or  a  heavy  schedule.  That  same 
semester  will  represent  your  first  pro- 
longed exposure  to  patients  and  clinical 
medicine  in  the  form  of  "Introduction  to 
Clinical  Medicine."  You  will  learn  how  to 
approach  patients,  to  perform  a  com- 
plete physical  examination,  and  to  for- 
mulate a  differential  diagnosis.  ICM  (the 
medical  world  is  noted  for  the  incom- 
prehensible proliferation  of  abbrevia- 
tions for  absolutely  everything)  will  be 
taught  all  day  Monday,  Wednesday, 
and  Friday.  The  other  longitudinal 
courses  will  be  on  Tuesday,  Thursday, 
and  Saturday. 

Then  follow  the  core  clinical  clerkships, 
elective  clinical  clerkships,  area  of  con- 
centration, and  additional  nonclinical 
requirements. 

The  core  clinical  clerkships  encompass 
three  continuous  months  in  medicine, 
two  continuous  months  in  surgery,  and 
a  single  month  in  three  of  the  following 
six  areas:  pediatrics,  obstetrics  and 
gynecology,  psychiatry,  neurology,  or- 
thopedic surgery,  and  dermatology- 
ophthalmology-otolaryngology  (triple 
threat).  Beyond  the  three  required 
months,  the  other  three  core  courses 
may  be  taken  during  the  elective 
period.  A  minimum  often  half-courses 
is  required  as  electives  and  must  in- 
clude at  least  three  nonclinical  electives 
and  at  least  four  clinical  electives,  the 
remainder  (three  half-courses)  are  free 
and  unrestricted.  The  nonclinical  elec- 
tives may  include  advanced  courses  in 
basic  science,  tutorials,  seminars,  re- 
search, or  anything  else  considered 
suitable  by  the  governing  bodies  which 
approve  courses.  Furthermore,  you  will 
be  required  to  choose  an  "area  of  con- 
centration" which  must  include  a 
minimum  of  six  half-courses.  Preclinical 
and  core  clinical  requirements  cannot 
be  applied  toward  fulfillment  of  the  area 
of  concentration  requirement.  However, 
the  additional  three  months  of  nonclini- 
cal electives  can  be  applied.  The  areas 
are  still  being  delineated,  but  the  fol- 
lowing suggestions  have  been  pro- 
posed: neurosciences;  behavioral  sci- 
ences; social  sciences;  reproductive 
and  developmental  sciences;  endocri- 
nology, metabolsim,  and  nutrition; 
musculoskeletal  and  connective  tissue; 
cardiovascular,  respiratory,  and  renal 
systems;  microbiology  and  infectious 
diseases;  and  oncology.  Let  me  em- 
phasize that  these  areas  may  be 


changed.  In  any  event,  areas  not 
clearly  subsumed  under  the  above 
categories  can  be  worked  out  between 
yourself  and  your  advisor  and,  if  ap- 
proved by  the  appropriate  committee, 
are  perfectly  acceptable  for  graduation 
credit. 

The  temporal  sequence  in  which  the 
core  clerkships,  nonclinical  electives. 
free  electives,  and  area  of  concentra- 
tion are  completed  is  entirely  up  to  your 
discretion,  barring  such  problems  as 
prerequisites.  Generally,  however,  it  is 
considered  advisable  to  take  Medicine 
and  Surgery  prior  to  the  fourth  year  in 
order  that  they  may  be  included  in  the 
evaluation  letters  sent  to  internship 
committees.  Otherwise,  there  is  no  uni- 
versally preferred  order.  One  advisor 
may  tell  you  one  thing;  another,  quite 
the  opposite. 

Approximately  25  members  of  your 
class  have  been  accepted  into  the 
Harvard-MIT  Program  in  Health  Sci- 
ences and  Technology  leading  to  the 
M.D.  degree  at  Harvard  Medical  School 
and  combining  the  facilities  and  talents 
of  MIT  and  HMS.  In  the  first  three 
semesters  it  stresses  the  physical  and 
technical  aspects  of  medicine  in  a  dis- 
tinct tract  within  the  larger  HMS  cur- 
riculum. After  the  first  semester  the 
HST  curriculum  is  substantially  organ- 
system  oriented,  and  from  the  fourth 
semester  onward  the  HST  and  HMS 
curricula  are  indistinguishable.  My 
principal  reason  for  mentioning  HST  in 
this  article  is  that  HMS  students  can 
elect  to  take  some  of  the  HST  courses. 
It  must  be  borne  in  mind,  however,  that 
probably  the  greatest  virtue  of  HST  is 
the  small  size  of  its  classes.  Some  may 
be  opened  to  more  students  than  previ- 
ously, but  this  is  entirely  speculative. 

All  students  will  be  graded  on  an 
Excellent-Satisfactory-Unsatisfactory 
system  during  the  preclinical  periods 

At  this  juncture.  I  will  give  you  a  slightly 
different  perspective  on  the  "new  cur- 
riculum" than  the  Administration  s  liter- 
ature and  speeches  at  orientation. 

To  begin  on  a  positive  note,  let  me  point 
out  that  of  the  approximately  30  mem- 
bers of  the  Curriculum  Committee, 
there  was  only  one  dissenting  vote  on 
the  question  of  approval  of  the  cur- 
riculum. Two  of  the  students  on  the 
committee  voted  for  approval:  one 


13 


(yours  truly)  voted  against.  The  Faculty 
of  Medicine  passed  it  in  two  sessions 
without  significant  modification.  The 
meetings,  however,  were  reported  to 
have  been  poorly  attended,  the  import 
of  which  is  equivocal  —  apathy,  as- 
suredness of  passage,  time  conflicts, 
poor  advertising,  etc.  Noteworthy,  too, 
is  that  except  for  the  three  students  on 
the  committee,  the  student  body  as  a 
whole  knew  precious  little  about  the 
formulation  or  content  of  the  change.  I 
would  venture  to  say  that  at  press  time 
students,  at  best,  knew  that  a  change 
had  occurred  and  were  slowly  gleaning 
the  details  by  word  of  mouth.  Needless 
to  say,  the  student  body  had  no  part  in 
the  approval  process.  In  the  interest  of 
fairness,  I  should  reiterate  that  the  old 
curriculum  remains  in  effect  for  the  cur- 
rently enrolled  student,  so  that  the  stu- 
dent interest  level  was  rather  low. 


Lab  session  on  rat  lung  during  respiratory  block  of  HMS  I. 


One  of  the  main  distinctions  between 
the  new  and  old  curricula  is  the  pre- 
dominance of  longitudinal  courses  in 
the  former  and  block  courses  in  the  lat- 
ter. We  had  basic  longitudinal  courses 
in  the  first  semester  and  in  the  second 
and  third  semesters  had  blocks  which 
dealt  with  most  of  the  salient  features 
—  physiology,  histology,  pathology, 
pharmacology  —  of  one  organ-system 
at  a  time,  such  as  cardiovascular  for 
five  weeks  and  renal  for  three  weeks. 
You  will  have  about  four  courses  run- 
ning concurrently,  and,  with  the  excep- 
tion of  pathophysiology,  they  will  not  be 
organ-system  oriented.  I  would  say  that 
the  blocks  have  been  well  received  by 
most  students.  The  alleged  disadvan- 
tage of  the  blocks  is  that  students  are 
exposed  to  a  subject  once,  in  a  short 
period  of  time,  with  little  repetition  or 
time  for  assimilation.  Some  believe  lon- 
gitudinal courses  will  remedy  these 
"shortcomings."  The  blocks  have  the 
advantage  of  integrating  the  teaching  of 
each  system.  The  longitudinal  ap- 
proach tends  not  to  tie  the  various  dis- 
ciplines together  as  well,  but  the 
pathophysiology  course  should  help 
serve  that  purpose.  I  wish  I  could  let 
you  decide  for  yourself  between  the  two 
modes  of  teaching,  but  the  choice  has 
been  made  for  you. 

Among  the  possible  advanges  of  the 
new  curriculum  are  the  potential  variety 
and  combinations  of  courses  in  each 
discipline  leading  to  the  M.D.  It  is  hard 
for  me  to  be  very  specific  about  this  as- 
pect, because  the  actual  courses  have 


yet  to  be  designed.  Generally,  flexibility 
would  seem  to  be  a  good  thing  but 
tends  to  be  overshadowed  somewhat 
by  most  students'  not  having  advanced 
standing.  Therefore,  for  the  first  three 
semesters  most  of  you  wil  be  inclined  to 
take  all  of  the  introductory  courses.  If,  in 
fact,  there  will  be  more  than  one  intro- 
ductory course  in  each  area,  as  there  is 
now  in  biochemistry,  that  will  create  a 
distinctly  advantageous  educational 
situation.  If  you  go  slower  than  your 
peers  initially  or  have  to  drop  a  course, 
which  is  permitted  within  the  first  half  of 
a  course,  you  will  be  able  to  catch  up 
without  losing  a  major  block  of  time. 

The  thrust  behind  the  three  required 
nonclinical  electives  has  been  the  re- 
peated complaint  by  clinicians  that  we 
have  not  been  sufficienctly  well  pre- 
pared in  basic  science  before  entering 
the  clinics.  Naturally,  the  basic  scien- 
tists are  pleased  by  the  additional  re- 
quirements. My  impression  is  that  stu- 
dents generally  do  not  take  too  kindly  to 
the  requirement  of  additional  basic  sci- 
ence. True,  many  students  have  at 
some  point  elected  to  return  to  the  class- 
room or  do  lab  work.  Clearly,  however, 
not  enough  students  have  had  that  urge 
to  satisfy  the  policy-making  bodies  of 
HMS;  hence,  the  new  requirements.  I 
am  not  sufficiently  far  along  in  my  med- 


ical education  to  know  how  well  or 
poorly  prepared  I  am  for  the  clinics. 
Nevertheless,  I  think  the  decision  to  re- 
turn to  the  classroom  should  be  an  indi- 
vidual one.  In  any  event,  you  may  take 
classroom  work  while  you  are  doing 
clinical  rotations;  Tuesday  and  Thurs- 
day afternoons  will  theoretically  be  free 
during  most  clerkships.  This  can  be  an 
excellent  opportunity  to  integrate  clini- 
cal and  classroom  exposure. 

Another  controversial  point  is  the  area 
of  concentration,  which  grew  out  of  the 
feeling  among  faculty  members  that 
students  have  tended  to  take  a  smor- 
gasbord distribution  of  electives  with 
"little  method  to  their  madness."  We 
have  about  14  months  of  unrestricted 
elective  time  during  which  some  have 
created  their  own  areas  of  concentra- 
tion and  others  have  tried  to  get  a  taste 
of  everything.  Strong  arguments  can  be 
made  for  either  approach.  One  positive 
feature  of  the  area  of  concentration  is 
that  it  may  engender  new  courses  in  es- 
tablished areas,  thus  adding  diversity 
and  decreasing  attrition  due  to  under- 
subscription.  If,  as  is  claimed,  there  will 
be  innumerable  combinations  of 
courses  acceptable  for  fulfillment  of  the 
area  of  concentration  requirement,  then 
hopefully  it  will  not  restrict  elective  free- 
dom. 


14 


Supposedly,  the  area  of  concentration 
will  familiarize  the  student  with  the  intel- 
lectual process  of  indepth  learning.  One 
argument  offered  against  the  require- 
ment was  that  because  most  Harvard 
Medical  students  do  eventually 
specialize,  they  need  not  narrow  their 
focus  as  undergraduates.  The  re- 
sponse was  that  students  hopefully 
would  choose  to  concentrate  in  a  field 
outside  their  eventual  area  of  speciali- 
zation. This  would  allow  one  to  broaden 
rather  than  narrow  one's  horizons.  This 
notion  rests  heavily  on  academic 
idealism  whereas  the  pragmatism  of 
many  students  would  dictate  spending 
this  time  within  their  area  of  interest. 
What  can  I  say?  I  hope  that  you  love 
learning  for  learning's  sake  enough  to 
follow  the  first  course  of  action. 


It  is  expected  that  the  requirements  in 
the  behavioral  and  social  sciences  will 
provide  impetus  for  the  development  of 
desperately  needed  substantive 
courses  in  these  areas.  Of  necessity,  a 
comprehensive  course  in  pharmacol- 
ogy will  be  offered  which  should  be  an 
improvement  over  the  rather  diffuse 
exposure  we  received.  Most  of  us  re- 
gret not  having  had  an  organized 
pharmacology  course.  In  addition,  the 
advisory  system  is  being  revamped  in 
order  to  provide  greater  continuity  in 
academic  counseling.  The  1 5  or  so  ad- 
visors to  be  elected  presumably  will  be 
"experts.''  Until  now,  any  faculty 
member  could  act  as  an  advisor,  and 
the  quality  of  advice  offered  by  indi- 
viduals has  been  grossly  disparate. 
Another  advantage  of  this  curriculum  is 


the  opportunity  those  with  strong  sci- 
ence backgrounds  have  to  push  ahead. 
Students  who  receive  advanced  stand- 
ing will  be  able  either  to  take  advanced 
courses  in  the  area  of  their  expertise  or 
electives  in  any  area  or  to  get  into 
pathophysiology  and  the  clinics  earlier. 

Finally,  let  me  leave  you  with  one 
thought  —  don't  be  overwhelmed  by 
Harvard  Medical  School.  It  is  an 
impressive  institution  with  good  faculty 
and  facilities,  but  you  were  selected  be- 
cause you  are  good;  and  as  long  as  you 
keep  yourself  together,  you  should  be 
able  to  cope  with  anything. 


The  Clinical  Year  and  Beyond 

by  Martha  J.  Macdonald  '74 


Curriculum  controversies  always  seem  to  focus  on  the  first  two  years  of  medical 
education.  Students  during  their  basic  science  training  have  very  little  first-hand 
contact  with  patients.  Therefore,  it  becomes  possible  to  lose  sight  of  the  object  of 
classroom  teaching.  Martha  J.  Macdonald  74,  now  a  pediatric  resident  at  the 
Massachusetts  General  Hospital,  looks  at  what  it  is  like  to  be  a  clinical  clerk  in  a 
Harvard  teaching  hospital. 


After  two  years  of  medical  school 
courses  (some  of  which  you  will  think 
exceedingly  irrelevant),  the  clinical 
years  will  burst  forth  with  the  promise  of 
relevancy  —  after  all,  the  clinic  is  what 
being  a  doctor  is  all  about.  You  will  find 
yourself  in  white  jacket,  stethoscope  in 
one  pocket,  black  notebook  (filled  with 
everything  you  should  know  about 
medicine  but  can't  retain  in  your  head) 
in  the  other  pocket,  and  black  bag  in 
hand  being  addressed  as  "Doctor 

,"  and  at  last  that  means  YOU!  You 

will  have  your  own  patients,  and  for  the 
first  time  since  entering  medical  school, 
your  responsibilities  will  be  to  others. 


You  will  be  a  functioning  and  important 
part  of  the  ward  team  composed  of  res- 
idents, interns,  and  medical  students. 
The  care  received  by  patients  assigned 
to  you  will  be  affected  by  what  interest 
you  show  in  them  —  not  only  in  their 
diseases  but  as  people  as  well.  Your 
raison  d'etre  no  longer  will  be  only  to 
learn  as  much  as  you  can.  You  will,  for 
most  of  your  core  clinical  clerkships, 
live  the  life  and  keep  the  hours  of  a 
house  officer,  learning  on  your  feet  from 
visits  (staff  physicians  assigned  to  your 
ward  team)  and,  to  an  even  greater  ex- 
tent, from  interns.  You  will  do  "scut" 
work  —  drawing  blood,  looking  at 


Pathology  session  during  cardiovascular 
blockofHMSI. 


15 


"Some  students  arrive  at  HMS  with  a  career  plan 
in  mind,  but  for  most  the  clinical  rotations 
determine  what  specialty  is  pursued." 


urines  and  doing  anything  else  the  in- 
tern is  too  busy  to  do.  That  means  tak- 
ing night-call  every  third  evening,  every 
third  day  in  rotation.  It  is  an  exciting 
year  which  will  leave  you,  albeit  ex- 
hausted, on  the  threshold  of  internship, 
transformed  into  a  competent  and  use- 
ful physician-to-be. 

Unlike  previous  classes,  your  class  will 
be  asked  to  concentrate  in  a  particular 
area  during  the  third  and  fourth  years. 
This  "concentration'  will  include  more 
basic  science  courses,  perhaps  re- 
search, and  further  clinical  courses. 
Classes  before  you  were  not  required 
to  have  any  specific  field  of  concentra- 
tion. Some  pursued  well-defined  re- 
search projects,  but  the  majority  took 
one-month,  subspeciality,  consult  clini- 
cal courses  such  as  cardiology,  infec- 
tious disease,  or  hematology.  This  style 
of  elective  choices,  also  known  as 


"berry  picking,"  left  many  disenchanted 
with  knowledge  gleaned  per  time  in- 
vested. Favorites  among  these  sub- 
specialty courses  have  been  family 
practice,  triple  threat  (eyes.  ears.  nose, 
throat,  and  dermatology  all  in  one),  ad- 
vanced medicine,  radiology,  the  infec- 
tious disease  one-month  lecture  in 
March,  and  psychiatry.  Courses  to  be 
avoided  at  all  costs  will  vary  each  year. 
It  is  a  good  practice  to  check  with  some 
friendly  upperclassmen  before  commit- 
ting yourself  to  courses  that  may  be 
disastrous.  Harvard  hospitals  include 
the  Massachusetts  General  Hospital, 
Peter  Bent  Brigham  Hospital,  Beth  Is- 
rael Hospital,  Children's  Hospital  Medi- 
cal Center,  Boston  Lying  In.  New  En- 
gland Deaconness  Hospital,  Cam- 
bridge Hospital,  and  the  Mt.  Auburn 
Hospital.  Courses  vary  in  each  hospital 
—  e.g.  cardiology  at  the  Mt.  Auburn 
Hospital  might  prove  to  be  most  valu- 


er. Walter  Gamble,  assistant  professor  of  pediatrics,  holds  a  clinic  during  the  cardiovascular 
block  of  HMS  I. 


able  while  cardiology  at  the  MGH  might 
be  a  bad  investment.  Some  students 
elect  to  take  courses  at  other  medical 
schools  in  other  states  or  countries. 
Obstetrics-gynecology  and  neurology 
are  particularly  popular  in  London.  Stu- 
dents planning  on  interning  outside  the 
confines  of  Boston  find  that  pursuing 
electives  in  hospitals  they  are  consider- 
ing acquaints  them  with  the  hospital 
and  improves  their  chances  of  being  of- 
fered a  position. 

Before  writing  this  article,  I  polled  HMS 
74  and  received  about  25  responses. 
Student  criticisms  of  the  clinical  years 
at  HMS  are  many.  Few  find  them,  as 
did  one  HMS  74,  "the  happiest  time  of 
my  life."  Even  the  most  motivated  stu- 
dents complain  that  the  experience  is 
tense  and  competitive  with  per- 
sonalities playing  a  very  important  role 
in  the  value  of  the  experience  —  not  to 
mention  the  evaluation  received  at  the 
end  of  each  course.  Teaching  is  too 
often  scanty  and  unorganized  without 
emphasis  on  public  health  measures  or 
on  the  delivery  of  health  care.  Time  in- 
vested is  maximal  but  often  inefficient. 
Yet  the  clinical  resources  at  Harvard 
Medical  School  are  vast,  unique,  and. 
for  many,  the  reason  they  chose  HMS. 

Beyond  the  clinical  years  lie  internships 
or  residencies.  Most  HMS  graduates 
get  an  internship  at  a  hospital  that 
ranked  in  their  top  three  choices.  Many 
stay  in  Boston  at  one  of  the  Harvard 
hospitals.  Another  large  contingent 
travels  to  the  West  Coast.  The  majority 
of  the  Class  of  1 974  took  internal 
medicine  internships  (96  students  out 
of  a  class  of  1 74);  surgery  (24  1 74); 
pediatrics  (20  1 74);  rotating  internships 
(11  174);  family  practice  (8  174);  and 
psychiatry  (8  1 74).  Three  students 
elected  to  take  pathology  residencies; 
two  obstetrics-gynecology:  one  radiol- 
ogy; and  one  neurosurgery.  Some  stu- 
dents arrive  at  HMS  with  a  career  plan 
in  mind,  but  for  most  the  clinical  rota- 
tions determine  what  specialty  is  pur- 
sued. Trends  this  past  year  have  shown 
a  decrease  in  the  popularity  of  surgery 
and  an  increase  in  the  popularity  of  the 
new  specialty  family  medicine.  Options 
open  to  medical  school  graduates  in- 
clude research  at  the  National  Institutes 
of  Health  (decreasing  in  popularity  with 
disappearing  draft  obligations)  and  fel- 
lowships in  a  variety  of  subspecialties 
following  one  or  two  years  of  in-hospital 
training. 


16 


The  Harvard-MIT  Program  in 
Health  Sciences  and  Technology 


by  Kenneth  R.  Bridges  '76 


Most  alumni  are  unaware  that  each  medical  school  class  is  subdivided  into  two 
groups.  The  overwhelming  majority  of  students  go  through  the  standard  cur- 
riculum, as  outlined  in  the  previous  article .  But  for  several  years  now,  an  elite  group 
of  25  students  has  enrolled  in  the  Harvard-M.I.T.  Program  in  Health  Sciences  and 
Technology.  They  attend  separate  classes  and  concentrate  more  on  the  basic  and 
physical  sciences.  Kenneth  H.  Bridges  76,  enrolled  in  the  program,  focuses  on  a 
special  type  of  medical  education  that  three  days  per  week  is  "on  the  other  side  of 
the  River." 


Rapid  growth  in  the  medical  sciences 
has  created  a  need  to  revise  the  tradi- 
tional concepts  of  medical  eduction. 
The  Harvard-M.I.T.  Program  in  Health 
Sciences  and  Technology  (HST)  is  the 
product  of  this  need.  It  realizes  that 
modern  physicians  must  be  able  not 
only  to  understand  and  to  control  the 
complex  machinery  of  medical  therapy, 
but  also  to  recognize  the  implications  of 
the  use  of  such  therapy  in  the  lives  of 
their  patients. 

The  HST  program  as  it  presently  stands 
is  a  curriculum  aimed  at  students  with 
strong  backgrounds  in  the  quantitative 
sciences  who  are  interested  in  main- 
taining that  same  type  of  rigorous  ap- 
proach while  pursuing  the  M.D.  degree. 
Just  as  during  the  1 930s  biological 
chemistry  was  making  its  debut  in 
medicine  with  the  promise  of  unfolding 
a  whole  new  realm  of  understanding  of 
disease,  so  today  other  areas  of  sci- 
ence, particularly  mathematics, 
physics,  and  engineering,  present  a 
great  hope  of  creating  new  inroads  into 
many  of  the  problems  still  apparent  in 
human  pathology.  The  structure  of  the 
program  opens  up  the  possibility  of 
doing  elective  course  work  at  M.I.T.  and 
Harvard  in  both  undergraduate  and 
graduate  departments  during  the 
course  of  medical  training.  Students 
admitted  to  the  HST  program  who  have 
further  work  to  do  on  undergraduate  or 
graduate  degrees  can  continue  with  a 
combined  degree  program,  while  other 
students  can  enroll  for  elective  courses. 
But  one  important  aspect  of  the  pro- 
gram which  has  yet  to  reach  its  full  de- 


velopment is  the  creation  of  an  aware- 
ness of  the  profound  social  implications 
of  medical  practice. 

The  need  for  this  type  of  medical  school 
program  was  recognized  as  early  as 
1966  when  Dr.  James  Shannon,  then 
the  Director  of  the  NIH,  proposed  that  a 
medical  school  be  founded  at  M.I.T. 
with  $60  million  in  initial  capital  supplied 
by  the  federal  government.  At  about  the 
same  time,  Dr.  David  Rutstein  and 
other  faculty  members  at  HMS  ap- 
proached Dean  Robert  H.  Ebert  with  a 
proposal  for  the  development  of  a  major 
biomedical  engineering  program  as  an 
adjunct  to  the  curriculum.  Talks  be- 
tween the  Dean  and  Dr.  Jerome 
Wiesner,  then  Provost  of  M.I.T.,  led  to 
the  creation,  in  1 967,  of  a 
Harvard-M.I.T.  faculty  committee  to  ex- 
plore the  possibility  of  joint  effort  in 
health  research,  delivery,  and  educa- 
tion. The  committee  met  for  two  years 
and  issued  a  report  expressing  the  be- 
lief that  fruitful  possibilities  existed  and 
that  a  concrete  planning  effort  should 
begin.  Dr.  Irving  M.  London,  then  pro- 
fessor of  medicine  at  Albert  Einstein 
Medical  School,  was  chosen  as  chair- 
man of  the  planning  committee,  and  in 
the  spring  of  1 970,  a  proposal  was  pre- 
sented and  accepted  by  the  faculties  of 
M.I.T.,  HMS,  and  the  Harvard  School  of 
Public  Health.  Dr.  London  remained  as 
director  of  the  HST  program,  and  the 
first  class  was  admitted  in  September 
1971. 

An  outline  of  the  structure  of  the  pro- 
gram can  be  found  in  the  catalogue,  but 


there  are  a  few  aspects  of  the  course 
arrangement  that  deserve  particular  at- 
tention. First,  the  longitudinal  course 
schedule  allows  students  to  participate 
in  other  courses  at  Harvard  and  M.I.T.. 
as  stated  previously.  In  addition,  this  ar- 
rangement allows  time  for  review  of 
course  work  over  the  semester  so  that 
the  material  can  be  learned  more 
thoroughly,  at  the  same  time  permitting 
integration  of  presentations  in  concur- 
rent courses.  Second,  all  courses  have 
a  strong  emphasis  on  student  involve- 
ment. An  example  of  this  is  the  student 
seminar  in  which  one  or  two  students, 
with  aid  from  a  faculty  advisor,  do  ex- 
tensive study  in  some  particular  area 
and  then  present  a  1 5  to  20  minute  dis- 
cussion of  the  topic.  Such  seminars  not 
only  are  informative  for  the  class  but 
also  increase  group  interaction.  And 
third,  the  neuroanatomy  course  in- 
cluded a  dissection  of  a  human  brain 
which  was  really  an  irreplaceable  teach- 
ing device.  Topologically  the  human 
brain  is  a  complex  organ,  and  it  is 
difficult,  if  not  impossible,  to  understand 
its  structure  solely  from  photographs 
and  drawings.  Students  were  free  to 
touch,  examine,  and  dissect  one  or 
more  brains  until  they  felt  that  the  con- 
cepts were  implanted  solidly  in  their 
minds.  This  is  an  example  of  an  impor- 
tant component  of  the  program,  that  is. 
making  students  key  figures  in  their 
own  educational  experience. 

Most  of  the  faculty  members  take  a  very 
strong  interest  in  the  students  and  in 
the  program  and  go  out  of  their  way  to 
learn  not  only  the  names  of  the  stu- 


17 


dents  but  also  a  little  about  them  per- 
sonally. Since  most  courses  have  a  rel- 
atively small  "core"  group  of  faculty 
members,  there  is  continuity  in  the 
teaching,  and  the  familiarity  between 
the  students  and  instructors  that  results 
helps  break  down  much  of  the  stuffy 
formality,  which  might  otherwise  per- 
vade. Most  students  are  pleasantly 
surprised  when  they  find  that  their  pro- 
fessors not  only  make  themselves 
available  but  even  actively  encourage 
students  to  come  in  and  talk.  Due  to 
student  feedback,  a  student-faculty 
Course  Evaluation  Committee  was 
created  specifically  to  review  the 
courses  at  the  end  of  each  semester. 
Practically  the  only  negative  point  about 
the  faculty  is  that  it  suffers  from  the 
same  problem  of  composition  as  the 
HMS  faculty  as  a  whole,  in  that  there 
are  very  few  women  or  minority  group 
members.  This  is  a  problem  which  must 
be  approached  from  a  Medical 
School-wide  perspective  before  it  can 
be  dealt  with  adequately. 

Like  the  faculty,  the  student  body  in  the 
program  is  small,  with  only  25  members 
per  class.  Most  of  the  students  have 
done  their  undergraduate  work  at  either 
Harvard  or  M.I.T.,  but  students  from 
other  schools  have  been  admitted  to 
the  program  and  have  adjusted  well. 
One  hindrance  to  the  expansion  of  the 
base  from  which  students  are  drawn  is 
that  the  HST  program  is  so  new  that 
few  people  from  other  universities  and 
colleges  are  familiar  with  it.  But  this 
problem  should  correct  itself  in  the  fu- 
ture as  descriptions  of  the  program  are 
included  in  catalogues  and  more  peo- 
ple come  into  contact  with  students  and 
graduates.  There  is  a  remarkably  wide 
range  of  interests  among  the  members 
of  the  program,  representing  such  di- 
verse fields  as  physics,  virology, 
economics,  and  anthropology.  But  the 
one  common  interest  shared  by 
everyone  in  the  program  is  learning  a 
rigorous,  quantitative  approach  to 
medicine  and  putting  this  approach  to 
work  in  whatever  areas  they  choose. 

There  are  a  number  of  on-going  ac- 
tivities that  add  personality  and  indi- 
viduality to  the  HST  program.  One  of 
these  is  the  Harvard-M.I.T.  Evening 
Seminar  Series.  The  evening  consists 
of  dinner  for  faculty,  students,  and 
friends  at  either  the  M. I. T.  or  the  Har- 
vard Faculty  Club,  followed  by  an  in- 
formal talk  by  a  distinguished  guest 


speaker.  Speakers  thus  far  have  in- 
cluded Dr.  Caroll  Williams,  professor  in 
the  department  of  biology  at  Harvard, 
Dr.  George  W.  Thorn,  Hersey  Professor 
of  the  Theory  and  Practice  of  Physic. 
Emeritus  at  the  Harvard  Medical 
School,  and  Dr.  Francois  Jacob,  pro- 
fessor of  molecular  genetics  at  the  Col- 
lege de  France  and  Nobel  Laureate. 
Also,  small  parties  at  the  ends  of 
courses  have  been  quite  popular,  with 
members  of  the  class  and  instructors 
taking  some  time  to  relax  and  get  to 
know  each  other  a  little  better.  Several 
courses  have  had  regular  coffee  and 
cookies  breaks.  And  one  day  in  the  gas- 
troenterology course  was  particularly 
pleasant  when  one  of  the  instructors 
brought  in  wine  and  cheese  for 
everyone. 

All  of  these  factors  have  added  up  to 
produce  a  program  that  is  exciting  and 
innovative  yet  personal  and  quite 
easy-going.  Medical  school  in  general 
has  a  notorious  reputation  as  a 


pressure-cooker  in  which  students 
grapple  and  gouge  their  way  through, 
following  only  the  law  of  the  jungle.  I 
have  found  very  little  of  this  in  the  HST 
program.  Students  work  hard  because 
that  is  what  they  have  been  trained  to 
do  over  the  years,  but  the  air  of  ac- 
rimonious competitiveness  has  been 
largely  absent.  By  the  same  token, 
most  faculty  members  have  taken  a 
serious  yet  relaxed  attitude  toward  the 
material  and  have  discouraged  com- 
petitiveness among  members  of  the 
class  while  encouraging  individual 
achievement.  These  factors  have 
added  together  to  produce  a  very  high 
level  of  contentment  with  the  program. 
With  most  new  institutions  or  programs, 
there  is  a  hard-core  group  who  com- 
plain about  any-and-everything.  But 
with  the  HST  Class  of  1 976,  anyway,  no 
one  I  know  regrets  coming  into  the 
program.  The  Harvard-M.I.T.  program 
is  young  and  will  continue  to  improve, 
but  already  it  has  taken  great  strides 
toward  achieving  its  goal. 


A  Non-Collective  View  of  the 
Biosocial  Curriculum 

by  Paul  S.  Appelbaum  '76 


The  original  version  of  Perspectives  contains  an  article  reprinted  from  the 
November  December  1973  Alumni  Bulletin  entitled,  "A  Collective  View  of  the 
Biosocial  Curriculum."  It  is  written  by  the  Biosocial  Curriculum  Collective,  a  group 
composed  of  all  the  student  members,  except  Paul  S.  Appelbaum  76,  on  the 
Dean's  Task  Force  on  a  Biosocial  Curriculum.  The  Collective  concludes  that  Har- 
vard Medical  School  should  develop  a  separate  track  of  courses  for  students  in- 
terested in  biosocial  medicine.  Among  its  most  controversial  proposals  is  Harvard  s 
training  of  community  physicians  who  would  not  have  direct  in-hospital  responsibil- 
ity for  their  patients.  The  article  is  thought-provoking  and  worth  reading  or  re- 
reading in  light  of  the  following  dissenting  viewpoint. 

The  fact  remains  that  there  has  been  very  little  progress  in  developing  a  biosocial 
curriculum.  Efforts  seem  to  be  stymied  because  of  unnegotiable  differences  be- 
tween the  Biosocial  Curriculum  Collective  and  the  faculty  members  on  the  Deans 
Task  Force  on  a  Biosocial  Curriculum.  Paul  Appelbaum  believes  the  Collective 
should  yield  somewhat  to  help  make  a  biosocial  curriculum  a  reality.  He  considers 
critically  the  bureaucratic  machinations  of  both  the  students  and  the  faculty. 


18 


For  many  years  the  biological  and  so- 
cial sciences  have  stood  as  antitheses 
at  distant  ends  of  a  spectrum  of  knowl- 
edge. Biological  science  was  "hard" 
science  which  could  be  directly  used  to 
improve  human  life  and  foster  human 
"progress."  Social  science  was  a  "soft 
endeavor,  at  best  the  concern  of  a  few 
imaginative  intellectuals,  at  worst  a 
sophisticated  blarney.  And  so  things 
stood  until  some  innovative  inves- 
tigators applied  their  experimental 
techniques  to  measure  the  overlap  be- 
tween the  biological  and  the  social  in 
the  field  that  lent  itself  most  to  such 
analysis  —  medicine.  The  results  were 
intriguing. 

It  was  found  that  years  of  patho- 
physiological training  were  being 
wasted  out  of  ignorance  of  sociology  — 
it  was  hardly  productive  to  instruct  a 
member  of  a  cultural  group  accustomed 
to  frequent  small  meals  during  the  day 
to  "take  one  pill  before  each  meal"  and 
expect  the  result  to  be  three  evenly 
spaced  doses.  Vast  numbers  of  pa- 
tients were  being  denied  available  med- 
ical treatment  because  of  lack  of 
knowledge  on  the  part  of  the  physicians 
of  political  economics.  Drugs,  ap- 
pliances, and  therapies  were  not  paid 
for  by  public  assistance  programs  and 
had  little  chance  of  being  purchased  by 
poverty-level  patients.  Simple  insen- 
sitivity  to  the  urgencies  of  human  exis- 
tence delayed  the  healing  of  disease.  A 
woman  who  alone  supported  and  cared 
for  her  five  children  was  quite  unlikely  to 
follow  the  advice  of  a  physician  who  in- 
structed her  to  "stay  off  your  feet  for  a 
few  days."  Results  such  as  these,  and 
the  findings  of  low  levels  of  compliance 
with  physicians'  instructions  in  many 
ethnic  groups,  suggested  that  the 
achievements  of  our  research 
laboratories  were  being  squandered  by 
medical  cadres  with  advanced 
scientific,  but  primitive  social,  training. 

The  widespread  feeling  that  our  current 
system  of  medical  education  was  pro- 
ducing physicians  with  central  blind 
spots  when  it  came  to  patient  care  led, 
in  recent  years,  to  many  proposals  for 
the  institution  of  a  "Biosocial  Cur- 
riculum" —  a  course  of  study  that 
trained  physicians  in  the  behavioral  and 
social  as  well  as  the  medical  sciences. 
Medical  leaders  across  the  country 
grew  fond  of  declaring  that  therein  lay 
the  future  of  medical  training.  Yet,  de- 
spite the  fact  that  such  statements  had 


become  commonplace  and  that  Dean 
Ebert  himself  had  expressed  such 
views,  Harvard  took  no  action  to  estab- 
lish a  biosocial  program  of  study.  Then, 
in  the  spring  of  1 973.  a  group  of 
dissatisfied  minority  students  formed 
the  Third  World  Caucus  and  demanded 
a  commitment  from  the  administration 
to  develop  a  Biosocial  Curriculum. 
Months  of  demands  and  meetings  cul- 
minated in  the  establishment  of  a  Task 
Force  on  the  Biosocial  Curriculum.  The 
Task  Force  was  chaired  by  Dr.  Leon 
Eisenberg,  chairman  of  the  Harvard 
Department  of  Psychiatry,  and  was 
composed  of  ten  other  faculty  members 
and  ten  students.  Of  the  students,  five 
were  members  of  the  Third  World 
Caucus,  one  was  a  representative  of  a 
small  group  of  "poor  white"  students, 
and  four  were  selected  at  random  from 
a  pool  of  interested  volunteers. 

This  heterogeneous  group  was 
charged  with  the  responsibility  of  plan- 
ning a  Biosocial  Curriculum  which 
would  then  be  submitted  to  the  dean 
and  the  faculty  for  approval.  Yet,  even 
now  substantive  work  on  a  curriculum 
has  not  begun,  and  the  committee  is 
mired  in  a  miasma  of  antagonisms  and 
philosophical  incompatibilities.  It  may 
well  be  instructive  to  consider  what  fac- 
tors, far  from  unique  to  Harvard,  have 
stymied  the  drive  for  a  Biosocial  Cur- 
riculum; the  stakes  for  medical  care  in 
the  country  as  a  whole  are  too  great  to 
permit  such  a  failure  to  be  repeated. 

If  we  accept  the  premise  that  the 
deficiencies  in  medical  education  out- 
lined above  are  real,  then  it  must  follow 
that  the  training  of  physicians  —  all 
physicians  —  should  be  altered  to 
eliminate  the  deficit.  The  consulting 
academic  neurologist  has  as  great  a 
need  for  effective  communication  with 
patients  as  the  primary  physician  in  a 
ghetto  clinic.  The  advice  of  the  cardiac 
surgeon  must  be  as  realistic  and  as 
scrupulously  adhered  to  as  that  of  the 
general  internist.  To  minister  effectively 
to  the  sick,  all  physicians  need  the  train- 
ing in  sociology,  economics,  and 
psychology  that  a  Biosocial  Curriculum 
would  provide.  This  suggests,  then,  a 
drastic  overhaul  of  the  preclinical  train- 
ing period,  requiring  either  elimination 
of  current  offerings  or  extension  of 
classroom  time  for  additional  social  sci- 
ence instruction. 

There  are  two  reasons  why  such  a  radi- 


cal alteration  in  medical  education  can- 
not be  accomplished  at  Harvard.  First, 
the  nature  of  faculty  politics  here  (su- 
perbly analyzed  in   Medical  Education: 
Harvard  Reverts  to  Tradition"  by 
Samuel  Z  Goldhaber  HMS  76. 
Science  181 :  1027-32)  is  such  that  an 
attempt  to  abbreviate  any  current  offer- 
ings would  arouse  the  fiercest  territorial 
instincts  of  each  department.  Already 
deprived  of  teaching  time  by  the  "core 
curriculum"  innovations,  the  preclinical 
faculty  would  never  consent  to  an  even 
greater  curtailment  of  their  influence  on 
medical  studies.  Second,  any  expan- 
sion of  the  current  preclinical  period 
would  be  consumed  by  those  Quad- 
rangle departments  with  the  most  politi- 
cal leverage.  This  is  precisely  what  has 
happened  in  the  latest  curriculum  revi- 
sion, which  resulted  in  the  abandon- 
ment of  the  "core. 

If  a  change  in  the  basic  course  of  in- 
struction is  clearly  out  of  the  question, 
how,  then,  did  Dean  Ebert  intend  the 
Task  Force  to  meet  its  goal  of  designing 
a  distinctive  program?  The  dean  fell 
back  on  the  model  established  by  the 
Harvard-M.I.T.  Program  in  Health  Sci- 
ences and  Technology: de  novo  con- 
struction of  a  small  program  with  inde- 
pendent admissions  and  separate 
courses  designed  to  produce  a  different 
kind  of  doctor.  Students  admitted  to  the 
Biosocial  program  would  be  expected 
to  become  "physicians  interested  in 
primary  care  and  community  medicine 
and  in  behavioral  science.   The  new 
general  practitioners  and  community 
psychiatrists  were  to  be  insulated  from 
the  rest  of  their  classmates  in  a  sepa- 
rate "track"  from  admission  to  the  com- 
pletion of  preclinical  training,  and 
perhaps  beyond.  Providing  adequate 
patient  care  was  thus  defined  as  the 
province  of  a  special  type  of  doctor  out- 
side the  realm  of  the  vast  majority  of 
Harvard  graduates. 

The  theoretical  justification  for  this  posi- 
tion was  provided  by  Dr.  Daniel  Funk- 
enstein.  a  Harvard  psychiatrist  who  has 
spent  many  years  exploring  the  selec- 
tion and  training  processes  of  physi- 
cians. His  studies  led  him  to  define 
three  types  of  medical  students: 
student-practitioners,  student- 
psychiatrists,  and  student-scientists. 
The  first  two  types  of  students  had  both 
scientific  and  social  interests,  intended 
to  pursue  careers  in  primary  care  of  the 
sick.  and.  hence,  would  benefit  from  the 


19 


Biosocial  Curriculum.  The  third  group, 
comprising  the  overwhelming  majority 
of  current  students,  had  a  narrow 
scientific  orientation  and  would  inevita- 
bly seek  academic  and  subspecialty 
careers.  From  this  schema  Funkenstein 
drew  two  curious  conclusions:  first, 
since  the  student-scientists  were  not  in- 
terested in  the  knowledge  that  the  so- 
cial sciences  had  to  offer,  any  attempt 
to  present  it  to  them  would  be  wasteful; 
and  second,  he  could  select,  at  the  time 
of  admission  to  medical  school,  those 
students  who  would  later  become 
primary-care  physicians.  This  deter- 
ministic viewpoint  excluded  from  the 
Biosocial  Curriculum  precisely  those 
students  who  were  most  in  need  of  it 
and  threatened  to  bias  the  program's 
admissions  against  whites,  especially 
white  males. 

This  is  the  background  against  which 
the  Task  Force  began  to  work.  Given 
this  situation,  a  group  of  individuals 
dedicated  to  the  goals  of  the  Biosocial 
movement  could  have  produced  a 
workable,  if  far  from  optimal,  document. 
Several  of  the  faculty  members  of  the 
Task  Force,  however,  were  far  from 
dedicated.  Many  failed  to  attend  a 
single  meeting,  and  few  were  present  at 
all  of  them.  It  was  when  they  were 
present  though,  that  the  greatest 
difficulties  arose.  Immediately  it  be- 
came apparent  that  a  large  proportion 
of  the  faculty  members  was  not  con- 
vinced of  the  desirability  of  the  new  cur- 
riculum. A  committee  formed  with  the 
notion  that  it  "should  explore  the  plan- 
ning of  a  .  .  .  [Biosocial  Curriculum]" 
now  found  its  first  task  was  convincing 
many  of  its  members  that  it  should 
exist.  The  questions  raised  by  the 
doubters  reflected  the  heterogeneity  of 
committee  viewpoints:  Weren't  general 
practitioners  anachronistic?  Couldn't  a 
nurse-practitioner  or  physician's  assis- 
tant do  the  job  just  as  well,  if  not  better? 
Wouldn't  a  national  program  of  Health 
Maintenance  Organizations  render  the 
graduates  obsolete?  And.  of  course, 
where  will  we  find  time  to  include  the 
necessary  courses  in  the  preclinical 
years? 

The  student  members  of  the  Task 
Force,  faced  with  questions  such  as 
these,  sensed  a  double-cross.  They 
were  there  because  of  their  commit- 
ment to  the  idea  of  joining  the  biological 
and  social  sciences,  and  they  had  as- 
sumed the  faculty  motives  were  similar. 


But  it  seemed  that  some  of  the  faculty 
members  had  been  appointed  to  the 
Task  Force  simply  to  delay  the  proceed- 
ings, slowing  it  in  a  quagmire  of 
conflicting  philosophies  of  medical 
practice.  This  was  a  crucial  juncture.  If 
the  students  had  adopted  a  practical 
policy  of  pushing  ahead  with  the  sub- 
stantive work  of  the  committee  and 
leaving  philosophy  at  the  sidelines,  the 
Task  Force  could  immediately  have 
begun  productive  work.  This  they  did 
not  do.  Instead  they  accepted  the 
gauntlet  flung  by  the  faculty  members 
and  decided  to  win  the  ideological  bat- 
tle before  proceeding  to  concrete  tasks. 

To  find  the  reasons  for  this  strategic 
decision,  we  have  to  turn  back  to  the 
composition  of  the  student  representa- 
tives. Two  of  the  four  randomly  selected 
students  never  appeared,  and  an  addi- 
tional Third  World  student  and  a  stu- 
dent with  close  ties  to  the  Third  World 
Caucus  took  their  places.  Most  of  the 
students  were  political  "radicals 
whose  approach  to  politics  had  been 
developed  in  the  campus  rebellions  of 
the  late  1960s.  They  viewed  the  Task 
Force  not  as  a  collection  of  individuals 
who  were  present  to  exchange  view- 
points and  reach  a  consensus  through 
open  debate  and  discussion  but  as  a 
negotiating  forum  where  two  inherently 
antagonistic  groups  met:  the  students, 
with  a  common  proposal  designed  in 
advance,  and  the  faculty,  whose  only 
option  was  to  accept  the  student  prop- 
ositions in  toto.  For  the  purposes  of 
these  negotiations,  all  the  student 
members  of  the  committee  except  I 
formed  the  Biosocial  Curriculum  Collec- 
tive. The  common  front  the  Collective 
presented  inevitably  turned  committee 
proceedings  into  an  adversary  process. 

An  interesting  sidelight,  indicative  of  the 
temper  of  committee  proceedings,  in- 
volved the  author,  the  only  student 
committee  member  not  part  of  the  Col- 
lective. Following  an  early  meeting  of 
the  Task  Force  at  which  he  vigorously 
opposed  a  thesis  offered  by  a  leader  of 
the  Collective,  he  was  the  object  of  a 
most  unusual  midnight  visit.  Two  mem- 
bers of  the  Collective  arrived  to  inform 
him  that  they  had  listened  again  to  his 
remarks  on  the  tape  they  had  made  of 
the  meeting  and  had  decided  that  his 
commitment  to  a  Biosocial  Curriculum 
was  severely  in  doubt.  Seating  them- 
selves on  his  floor,  they  proceeded  to 
suggest  that  his  involvement  with  the 


committee  was  for  the  benefit  of  his  in- 
ternship application  and  that  if  he  con- 
tinued to  verbally  oppose  Collective 
positions,  resignation  was  his  only  hon- 
orable option.  Nothing  came  of  the 
half-hour  visit  except  a  heightened  ap- 
preciation of  committee  dynamics. 

The  Collective  developed  a  theoretical 
stance  in  reply  to  the  faculty  challenge 
and  in  accordance  with  their  ideological 
inclinations.  Their  comments  were  pub- 
lished in  a  carefully  documented  "Re- 
port of  the  Biosocial  Curriculum  Collec- 
tive on  Biosocial  Medical  Education." 
Their  report  delineated  the  nature  of  the 
physician  they  expected  the  program  to 
produce  and  justified  each  element  of 
their  proposal.  Their  goal  was  to  deliver 
primary  care  in  a  community  of  which 
such  a  physician  would  be  a  resident 
and  actively  engage  in  political  actions. 
Practice  would  be  limited  to  out-patient 
medicine  and  care  of  hospitalized  pa- 
tients would  be  undertaken  by 
hospital-based  specialists.  The  physi- 
cian would  be  singularly  concerned  with 
preventive  medicine. 

Given  this  theoretical  groundwork,  the 
faculty  responded  to  what  they  felt  were 
weaknesses  in  the  analysis.  Even  fac- 
ulty members  who  had  previously  shied 
away  from  the  teleological  controver- 
sies felt  obliged  to  attack  what  they  saw 
as  weaknesses  in  the  Collective  s  posi- 
tion. They  argued  that  the  Collective's 
end-product  was  undesirable.  The  stu- 
dent would  be  trained  to  work  in  a  sys- 
tem that  did  not  exist  and  might  never 
exist,  instead  of  being  trained  to  make 
the  best  of  opportunities  in  the  current 
structure.  The  continuity  of  patient  care 
would  be  threatened  by  denying  hospi- 
tal privileges.  The  new  physician  would 
be  forced  into  an  inflexible  social  and 
personal  situation  by  mandating  resi- 
dence in  the  community  of  one's  prac- 
tice. Commitment  to  and  productivity  in 
medicine  would  be  diminished  by  time 
spent  in  political  endeavors  that  could 
be  better  handled  by  others. 

The  Collective  was  caught  in  a  logical 
dilemma.  To  assert  that  it  was  right  and 
the  faculty  was  wrong,  when  both  were 
arguing  unprovable  notions,  would  be 
viscerally  satisfying,  but  would  doom 
the  future  of  the  committee.  Yet  the  only 
way  out  of  the  maze  was  to  argue  that 
the  Biosocial  Curriculum  would  be 
beneficial  for  everyone  who  completed 
it.  This  was  counter  to  initial  contentions 


20 


that  the  social  and  political  structure 
within  which  a  physician  practiced  was 
the  most  important  determinant.  To  ac- 
complish the  shift  would  have  required 
the  Collective  to  begin  to  approach  the 
Biosocial  question  from  the  educational, 
instead  of  the  political,  perspective. 

Whether  the  Collective  could  have 
negotiated  such  a  shift  or  whether 
some  other  way  would  have  been  found 
out  of  the  committee's  dilemma  can 
never  be  known.  When  theoretical  dis- 
putes sapped  its  momentum,  the  Task 
Force  simply  stopped  meeting  in  the  fall 
of  1973.  Ostensibly,  subcommittees 
were  formed  to  design  individual  parts 
of  the  curriculum,  but  nothing  has  been 
heard  from  any  of  them. 


The  object  lessons  of  this  case  study 
are  relevant  to  a  wide  range  of  interac- 
tions at  HMS.  The  faculty  are  con- 
cerned with  prestige  and  with  power. 
Like  any  other  middle-level  bureauc- 
racy, they  operated  with  a  strong  pre- 
sumption in  favor  of  the  status  quo.  The 
core  curriculum  was  abolished  six 
years  after  its  inception  because  the 
basic  science  faculty  had  never  been 
reconciled  to  the  loss  of  power  that  its 
adoption  entailed.  They  had,  moreover, 
never  been  given  a  reason  to  want  it  to 
succeed.  This  concern  with  power  can, 
however,  be  turned  to  advantage.  For  if 
the  faculty  are  given  a  stake  in  the  suc- 
cess of  a  program,  if  they  are  made  re- 
sponsible for  its  development  and  im- 
plementation and  held  accountable  for 


its  failure,  then  their  considerable 
power  can  be  mobilized  for  innovation 
Few  are  the  instances  in  which  the  key 
to  success  of  a  proposal  lies  elsewhere; 
alienation  of  the  faculty  almost  always 
assures  defeat. 

The  actions  of  the  Biosocial  Curriculum 
Collective  belie  the  assertion  that  the 
age  of  ideology  has  come  to  an  end. 
Once  more,  the  unwillingness  of  propo- 
nents of  radical  change  to  place  their 
ideology  aside  and  concentrate  on  the 
immediate  task  has  led  to  the  alienation 
of  potential  allies,  tactical  deadlock,  and 
strategic  defeat.  And  there  it  stands, 
much  as  it  did  a  year-and-a-half  ago. 
with  Harvard  still  making  no  effort  to 
train  the  complete  physician. 


Part  III  -  Diversity 


Married  Students 

by  Mark  J.  Greenwald  '76 


The  purpose  of  "Part  III  —  Diversity''  is  to  heighten  awareness  of  the  many  dif- 
ferent types  of  students  at  Harvard  Medical  School.  One  of  the  neglected 
minorities,  especially  during  the  first  year,  is  the  married  medical  student,  who 
simultaneously  must  face  new  family  as  well  as  academic  challenges.  Mark  J. 
Greenwald  76  gives  a  brief  overview  of  various  problems  a  married  couple  may 
encounter. 


Social  Life 

Social  adjustments  can  be  difficult  for 
the  married  medical  student  during  the 
first  year.  You  will  find  that  your  fellow 
students  who  live  in  Vanderbilt  Hall  get 
to  know  each  other  rapidly  while  you 
will  become  acquainted  with  the  class 
much  more  slowly.  You  probably  will 
also  find  that  your  social  needs  and 
interests  are  quite  different  from  those 
of  your  unmarried  classmates.  The  best 
approach  combines  patience  and  a  cer- 
tain amount  of  aggressiveness  in  meet- 
ing people.  Amphitheatre  C  provides  lit- 
tle opportunity  for  social  contact,  but 
through  the  small  lab  sections  you  will 
get  to  know  at  least  a  few  students  early 


in  the  year.  Eating  lunch  in  Vanderbilt 
Hall  can  be  a  good  way  of  expanding 
your  circle  of  acquaintances.  When  you 
enter  the  clinic  in  the  second  year,  the 
learning  situation  becomes  much  more 
intimate,  and  friendships  develop 
quickly. 

During  the  course  of  the  first  year  you 
gradually  will  get  to  know  the  other  mar- 
ried students  in  the  class  and  undoubt- 
edly will  find  that  they  have  shared  the 
same  sense  of  initial  isolation.  The 
sooner  you  discover  each  other  the 
more  pleasant  your  first  year  will  be. 
Don't  hesitate  to  take  the  initiative  in 


this  matter  —  you  can  be  confident  it 
will  be  welcomed  by  your  fellow  married 
students. 


Spouses  &  Children 

Job  hunting  can  be  a  discouraging  ex- 
perience for  the  medical  student  s  hus- 
band or  wife  because  Boston  is  so 
overpopulated  with  college  graduates. 
Many  positions  that  elsewhere  would 
go  to  persons  with  a  B  A.  are  filled  by 
those  with  a  Master  s  or  more  Teach- 
ing, in  particular,  tends  to  be  over- 


21 


subscribed,  although  openings  do 
occur.  There  are  always  numerous  sec- 
retarial and  clerical  posts  available  in 
both  businesses  and  the  local  univer- 
sities. University  pay  scales  tend  to  be 
lower  than  those  of  private  enterprise; 
but  the  atmosphere  is  more  comfort- 
able, and  there  may  be  opportunities  to 
take  courses  at  little  or  no  charge. 
There  are  also  frequent  openings  for 
medical  technicians  in  the  local  hospi- 
tals for  which  no  previous  experience  or 


training  are  required.  Apply  for  these  di- 
rectly to  the  hospital,  not  through  the 
Medical  School,  and  mention  that  you 
are  a  medical  student's  spouse. 

The  Boston  area  abounds  in  high  qual- 
ity day  care  centers  and  nursery 
schools  of  every  educational  persua- 
sion as  a  consequence  of  the  large 
concentration  of  academic  and  profes- 
sional families.  For  information  about 
these,  contact  the  Child  Care  Resource 


Center  in  Cambridge  or  the  local  De- 
partment of  Public  Health. 


Presently  plans  are  being  formulated  by 
the  office  of  student  affairs  to  assign 
each  entering  student  an  upper  class 
tutor,  and  hopefully  all  the  married  stu- 
dents will  be  assigned  married  students 
as  tutors.  Feel  free  to  ask  them  any 
questions  you  have  and  to  discuss 
problems  you  encounter  in  adjusting  to 
life  in  Boston  or  HMS. 


Women 


by  Maria  C.  Savoia  '76 


Maria  C.  Savoia  76  devotes  much  of  her  time  to  promoting  the  rights  of  women  in 
medicine  and  to  combatting  subtle  and  blatant  manifestations  of  sexism.  She 
works  closely  with  Dr.  Mary  Howell,  Associate  Dean  for  Student  Affairs.  Maria 
Savoia's  article  presents  the  historical  roots  of  sexism  at  Harvard  Medical  School. 


"What's  a  nice  girl  like  you  doing  at  a 
place  like  this?'' 

"For  vehemence  and  personal  animos- 
ity almost  resulting  in  disaster,''  writes 
Thomas  F.  Harrington  in  The  Harvard 
Medical  School,  A  History,  Narrative 
and  Documentary  (1905),  "no  recent 
controversy  equals  that  in  1 882  over 
admission  of  women  to  the  Harvard 
Medical  School.  "1  Until  the  beginning 
of  the  19th  century,  women  appeared  in 
American  medical  history  principally  as 
midwives.  but  after  the  establishment  of 
the  first  medical  school  for  women  in 
Boston  in  1848.  women  began  to  seek 
formal  training  at  other  established 
medical  colleges.  In  1 878  Harvard  was 
offered  S1 0,000  by  a  prominent  Boston 
family  if  it  would  make  available  its  ad- 
vantages to  women  on  equal  terms  with 
men.  This  offer  prompted  a  resolution 
"favoring  educating  women  in 
medicine,  providing  a  sufficient  sum  of 
money  (S200.000)  could  be  obtained  to 
warrant  the  Corporation  in  doing  so."2 
Although  19th  century  feminists  appar- 
ently sought  to  raise  this  sum,  on  May 
24, 1879,  a  revote  deemed  it  "detrimen- 
tal to  the  interests  of  the  School  to 
admit  women.  "3  When  the  question 
was  again  raised  in  1882,  a  vote  of 
13-12  denying  women  admission  "pre- 
vented the  resignation  of  the  whole 
Faculty."4 


The  question  surfaced  for  a  final  time  in 
1 943.  nearly  a  century  after  the  first 
woman  had  graduated  from  an  Ameri- 
can medical  school  (Elizabeth  Black- 
well  received  her  M.D.  in  1 847  from 
Hobart)5  and  just  two  years  less  than  a 
century  after  the  first  proposal  to  admit 
women  was  submitted  to  the  President 
and  Fellows  of  Harvard  College.  On 
April  2.  1 943,  in  accordance  with  the 
recommendations  of  a  faculty  commit- 
tee, the  Faculty  of  Medicine  voted  to  rec- 
ommend to  the  governing  boards  that 
the  admission  of  women  be  authorized 
as  an  immediate  and  permanent  policy 
and  that  "the  proportion  of  women  to 
men  admitted  each  year  be  decided  by 
the  Committee  on  Admission  solely  on 
the  basis  of  the  quality  of  the 
applicants."6  On  June  5,  1944,  the 
governing  boards  voted  to  approve  the 
recommendation  of  the  faculty,  and  12 
women  were  admitted  as  members  of 
the  Class  of  1949. 

The  percentage  of  women  admitted  to 
HMS  remained  relatively  constant  over 
the  next  20  years.  Approximately  five 
years  ago,  concomitant  with  the  re- 
vitalization  of  the  feminist  movement 
the  number  of  women  medical  students 
began  and  has  continued  to  rise.  There 
are  1 9%  women  in  the  Class  of  1 975, 
23%  in  the  Class  of  1 976,  27%  in  1 977, 
and  33%  women  expected  in  the  Class 


of  1978.  Although  these  percentages 
are  above  the  national  mean  of  women 
accepted  by  medical  schools,  no  ad- 
missions committee  should  rest  com- 
fortably until  their  admissions  statistics 
reflect  population  statistics. 

Is  there  discrimination  against  women 
at  Harvard?  Margaret  Campbell,  M.D.. 
in  her  book "  Why  would  a  girl  go  into 
medicine?"  Medical  Education  in  the 
United  States:  A  Guide  for  Women, 
states   It  appears  that  all  medical 
schools  exhibited  some  degree  of  dis- 
crimination against  women  students,  if 
only  because  discrimination  against 
women  has  been  and  is  the  accepted 
pattern  in  our  society.  Bias  and  prej- 
udice against  women  entering  a  man's 
profession  take  their  own  special  forms, 
but  they  are,  in  the  end.  only  particular 
manifestations  of  the  more  generalized 
bias  and  prejudice  shown  to  all 
women."7 

For  most,  simply  being  a  medical  stu- 
dent is  clearly  more  significant  than 
being  a  woman  medical  student;  men 
and  women  alike  experience  the  same 
terror  before  the  first  biochemistry 
exam,  the  same  trepidation  interview- 
ing their  first  patient.  But  women  do 
face  barners  of  a  sort  men  do  not.  They 
must  cope  with  demeaning  sexual 
stereotypes;  they  often  juggle  the  de- 


22 


manding  responsibilities  of  family  and 
career  without  the  help  of  an  "at  home 
spouse;  and  they  may  feel  more  acutely 
the  plight  of  women  patients  who  seek 
care  from  a  system  that  tends  to  make 
derisive  assumptions  about  women's 
psyche  and  capabilities. 

Many  women  medical  students  have 
found  it  helpful  to  join  other  women  in 
the  medical  area.  The  Harvard  Medical 
Area  Women's  Group  is  a  loose  as- 
sociation of  faculty,  house  officers,  stu- 
dents, and  employees  which  began 
meeting  in  1971  and  seeks  to  foster 
discussion  about  and  improvements 
of  the  status  of  women  at  Harvard. 
From  this  group  came  the  proposal  to 
establish  the  formal  26  member  Joint 
Committee  on  the  Status  of  Women  at 
the  Harvard  Medical  School,  Dental 
School,  and  School  of  Public  Health, 
appointed  in  1973  by  Deans  Robert 
Ebert,  Paul  Goldhaber,  and  Howard 
Hiatt.  This  official  Harvard  committee, 
also  representing  the  interests  of 
women  students,  faculty,  house 
officers,  and  employees,  is  document- 
ing the  current  situation  for  women  and 
making  recommendations.  Both  the 
Harvard  Medical  Area  Women's  Group 
and  the  Committee  on  the  Status  of 
Women  strongly  desire  student  partici- 
pation and  impact.  Certainly  the  situa- 
tion will  improve  as  more  women  enter 
the  medical  profession,  find  support  in 
each  other,  and  seek  solutions  to  com- 
monly shared  problems. 

Footnotes: 

1 .  Thomas  F.  Harrington,  The  Harvard 
Medical  School.  A  History  Narrative  & 
Documentary  (3  Vols.,  New  York: 
Lewis  Publishing  Co..  1905)  p.  1217. 

2.  Ibid,  p.  1224. 

3.  Ibid.  p.  1234. 

4.  Ibid,  p.  1217. 

5.  Ibid,  p.  1218. 

6.  George  Packer  Berry,  M.D.. 
Foreword  to  "The  First  Decade  of 
Women'  in  the  Harvard  Medical 
School  (Boston,  Harvard  Medical 
Alumni  Association,  1 959)  p.  1 1 . 

7.  Margaret  A.  Campbell,  "Why  would 
a  girl  go  into  medicine  ? "  Medical  Edu- 
cation in  the  United  States :  A  Guide  for 
Women  (Margaret  A.  Campbell,  1973) 
p.  1 .  (Valuable  and  interesting  reading 
for  any  woman  contemplating  going  to 
medical  school.  Copies  are  available 
from  Ann  O'Shea,  Dept.  SL.  320  West 
End  Ave.,  Apt.  6B,  NY,  NY.,  10023.) 


Third  World  Students 

by  Kenneth  R.  Bridges  '76 


To  endeavor  to  write  about  such  a  diverse  group  as  Third  World  students  is  to  ac- 
cept a  most  difficult  challenge.  Yet  Kenneth  R.  Bridges  76.  a  black  medical  stu- 
dent involved  with  the  Black  Health  Organization,  has  written  a  perceptive  and 
comprehensive  article.  He  has  worked  for  the  rights  of  Third  World  students  with 
Dr.  Alvin  F.  Poussaint,  Associate  Dean  for  Student  Affairs. 


It  is  a  singularly  difficult  task  to  charac- 
terize Third  World  students  at  Harvard. 
Not  only  is  there  a  great  deal  of  diver- 
sity among  the  students;  any  one 
person's  impressions  will  be  colored 
distinctly  by  individual  beliefs  and  prej- 
udices. But  forewarned  is  forearmed. 
Always  keep  in  mind  that  you  can  come 
to  know  and  to  understand  Third  World 
students  only  by  meeting,  talking,  and 
exchanging  ideas  with  them. 

And  it  must  also  be  kept  in  mind  that  the 
fairly  substantial  number  of  Third  World 
students  at  HMS  is  a  very  recent 
phenomenon.  There  has  been  a  trickle 
of  Blacks  and  other  minorities  through 
the  faucet  for  a  long  time,  but  never 
enough  to  fill  the  basin.  In  fact,  in  1 968 
there  were  only  five  black  students  pur- 
suing the  M.D.  degree  at  this  institution. 
But  1 968  represented  a  year  of  confron- 
tation both  for  HMS  and  for  the  nation. 
Catalyzed  by  four  years  of  Black 
people's  forceful  resistance  to  oppres- 
sion, spurred  by  the  growing  sense  of 
solidarity  in  the  Chicano  and  Boricua 
communities,  and  shocked  by  the  as- 
sassination of  Dr.  Martin  Luther  King,  in 
May,  1 968,  278  members  of  the  student 
body  of  HMS  sent  a  petition  to  Dean 
Robert  H.  Ebert  in  which  they  ex- 
pressed a  belief  that  "the  response  of 
the  white  community  can  act  to  promote 
or  prevent  the  further  deterioration  of 
life  in  our  inner  cities  and  relations  be- 
tween the  races.''  They  called  upon  the 
faculty  of  the  Harvard  Medical  School 
to  establish  a  high-level.  Medical 
School-wide,  fact-finding  commission 
to  assess  the  potential  contribution  of 
the  Harvard  Medical  community  to  the 
improvement  of  the  lives  of  the 
country's  poor  and  disadvantaged.  In 
response  to  this  petition  and  a  letter  of 


similar  tone  signed  by  eleven  senior 
faculty  members,  the  Commission  on 
Relations  with  the  Black  Community 
was  created. 

Dr.  Leon  Eisenberg,  chairman  of  the 
Commission,  prefaced  the  report  to  the 
dean  with  a  statement  that  "all  of  us 
have  tolerated,  if  not  created,  a  social 
structure  whose  outcome  has  been  ra- 
cist, whether  it  was  consciously  in- 
tended or  not.  To  the  victim,  it  mattered 
little  whether  the  outcome  was  in- 
tended." Proposals  were  generated  by 
the  report  to  increase   significantly"  the 
number  of  minority  students  at  HMS.  to 
establish  a  Health  Careers  Summer 
Program  designed  to  give  under- 
graduate minority  students  an  exposure 
to  Harvard  via  the  Summer  School  in 
Cambridge,  and  to  provide  more  effec- 
tive health  care  to  the  Third  World 
Communities  through  neighborhood 
health  clinics.  All  of  these  proposals 
have  been  enacted  and  are  still  being 
implemented,  with  more  success  in  the 
former  two  cases  than  in  the  latter 

Dean  Ebert  played  a  major  role  in  the 
augmentation  of  Third  World  students 
at  Harvard.  Although  the  Commission 
report  focused  primarily  on  the  relation- 
ship of  the  Medical  School  to  the  Black 
community,  the  dean  recognized  that 
the  attack  on  existing  inequities  had  to 
be  larger  in  scope  and  include  all  mem- 
bers of  the  Third  World:  Blacks. 
Chicanos,  Boricuas  (Puerto  Ricans). 
and  Native  Americans.  Associate  Dean 
of  Student  Affairs  at  Harvard.  Dr  Alvin 
F.  Poussaint.  was  a  key  figure  not  only 
in  the  recruitment  projects  designed  to 
get  more  minority  students  into  the 
Medical  School  but  also  in  the  promo- 
tion of  social  and  other  ancillary  func- 


23 


tions  aimed  at  attenuating  adjustment 
problems  once  the  students  matricu- 
lated. 

But  one  important  point  of  clarification 
must  be  made  relative  to  the  proposal 
that  "disadvantaged"  students  be  ad- 
mitted to  the  Medical  School.  With  few 
exceptions,  Harvard  has  not  admitted 
minority  students  with  admissions 
qualifications  that  cannot  be  matched  to 
those  of  some  of  the  other  students  in 
the  class. 

In  the  fall  of  1 969,  20  Third  World  stu- 
dents were  included  in  the  entering 
class,  and  few,  if  any,  of  them  could  be 
called  educationally  disadvantaged.  A 
number  of  them  had  postgraduate  de- 
grees including  Ph.D.'s,  and  all  were 
qualified  applicants.  One  person  com- 
pleted his  degree  requirements  in  three 
years.  Third  World  students  who  have 
come  to  this  institution  thus  far  have 
had  the  capacity,  motivation,  and 
qualifications  both  to  perform  and  to 
excel.  Many  people  would  hang  the 
"disadvantaged"  label  on  any  student 
from  a  predominantly  Black  school,  but 
these  students  have  performed  as  well 
as,  or  better  than,  their  peers  from  the 
majority  group.  Interestingly,  there  has 
been  a  marked  flux  in  the  backgrounds 
of  the  students  admitted  to  the  Medical 
School.  Whereas  the  Class  of  1 974  in- 
cluded six  persons  from  predominantly 
Black  colleges  in  its  ranks,  the  Class  of 
1 977  has  only  one  person  from  such  an 
institution.  With  the  prospective  Class 
of  1 978.  the  number  is  back  up  again,  to 
three.  The  primary  cause  for  this  vacil- 
lation is  that  there  are  no  quotas  for 
Third  World  students  from  any  school, 
so  that  outstanding  students  are  admit- 
ted without  regard  to  their  under- 
graduate locale. 

Aside  from  their  general  academic 
qualifications,  there  is  little  else  that  can 
be  deemed  "characteristic."  Minority 
students  at  HMS  exemplify  diversity  in 
background,  interests,  and  goals.  A 
number  of  the  students  grew  up  in  mid- 
dle and  upper-middle  class  environ- 
ments sharing  many  of  the  same  edu- 
cational and  cultural  experiences  as 
members  of  the  majority  group.  In  con- 
trast, other  students  came  from  humble 
beginnings  among  the  rural  or  urban 
poor  and  have,  mainly  through  their 
own  assiduous  effort  and  fortitude, 
made  their  way  to  upper  echelons.  And 
as  backgrounds  vary,  so  do  aspirations, 


each  class  including  in  its  ranks  clini- 
cians and  primary  care  physicians  as 
well  as  research  specialists  and 
academicians. 

Variety  is  also  seen  in  the  general  ex- 
periences which  Third  World  students 
have  while  at  HMS.  The  clinical  clerk- 
ship years  are  probably  more  vulnerable 
to  the  vicissitudes  of  human  whim  than 
any  other  aspect  of  medical  education. 
Interpersonal  relationships  play  a  very 
large  role  in  the  course  of  these  years, 
and,  as  in  any  circumstance  where  two 
humans  come  face-to-face,  subjectivity 
is  unavoidable.  More  often  than  not  the 
student  is  treated  fairly  (or  at  least  no 
differently  from  anyone  else),  and  no 
problems  are  encountered.  But  in  many 
aspects  Harvard  is  merely  a  reflection 
of  the  society  from  which  it  draws  its 
life,  and  in  that  sense  it  can  be  no  pret- 
tier than  that  society  as  a  whole.  Some 
students  have  gone  through  the  entire 
four  years  and  have  never  been  singled 
out  for  "special"  treatment.  Others  have 
been  less  fortunate. 

When  problems  such  as  these  or  others 
occur,  it  is  essential  to  be  able  to  turn 
with  confidence  for  advice  and  aid.  And 
in  this  area.  Harvard  excels.  There  are 
always  people  ready  and  willing  to 
reach  out  and  lend  a  hand.  There  is  a 
tradition  among  the  upper-class  stu- 
dents of  "taking  care  of  our  own." 
Brothers  and  Sisters  are  ready  and  will- 
ing to  give  advice  and  counsel  not  only 
about  "shop  matters"  such  as  courses, 
books,  and  study  techniques,  but  also 
about  more  personal  matters  such  as 
relating  medical  education  to  one's  ul- 
timate goals  in  life  or  avoiding  de- 
humanization  while  becoming  a  part  of 
"the  medical  machinery."  For  the  in- 
coming student,  the  upperclassman  is  a 
most  valuable  asset.  In  addition,  there 
are  capable  and  sincere  faculty  mem- 
bers and  advisors  who  are  very  helpful 
in  aiding  Brothers  and  Sisters  in  coping 
with  many  of  the  general  problems  they 
might  face,  such  as  electives,  reading 
courses,  reference  material,  and  the 
like.  And  many  people  willing  to  take 
the  time  have  created  strong  ties  with 
people  in  the  various  communities  of 
Boston,  broadening  their  realm  of  ex- 
perience beyond  the  walls  of  the  Medi- 
cal School. 

Others  have  expanded  their  interests 
by  participating  in  student  organizations 
both  inside  and  outside  the  Medical 


School  framework.  One  of  these,  the 
Black  Health  Organization,  was 
founded  in  1 970  and  is  designed  for  the 
varied  interests  and  talents  of  Black 
students  in  both  the  Dental  and  Medical 
Schools  as  well  as  the  Division  of  Medi- 
cal Sciences  (graduate  students).  One 
of  the  primary  activities  of  this  organiza- 
tion in  the  past  has  been  the  counseling 
of  undergraduate  students  interested  in 
the  medical  sciences  and  related  health 
care  fields.  Although  activity  has  cen- 
tered around  the  Boston  area  recently, 
many  members  of  the  BHO  have  in  the 
past  made  trips  to  predominantly  Black 
colleges  in  the  South,  and  a  number  of 
Third  World  students  were  recruited  to 
the  Medical  School.  Other  programs 
designed  to  give  disadvantaged  stu- 
dents in  the  Boston  area  school  system 
greater  exposure  to  science  have  been 
implemented  successfully.  In  the  past 
students  from  the  BHO  have  been  ac- 
tively involved,  as  well,  in  the  Health 
CareersSummerProgram,  bothasmem- 
bers  of  the  admissions  committee  and  as 
academic  tutors  during  the  summer. 

Another  organization  which  has  been 
extremely  active  and  productive  is  the 
Boricua  Health  Organization.  Created 
in  1972,  this  organization  has  been  a 
leader  in  addressing  the  particular  prob- 
lems faced  by  Boricua  medical  and 
premedical  students.  Among  the  many 
projects  overseen  by  this  group  has 
been  a  massive  mailing  campaign  of 
pamphlets,  posters,  and  leaflets  aimed 
at  undergraduate  students  and  de- 
signed to  create  and  maintain  an  in- 
terest in  the  health  field.  This  has  been 
followed  up  by  recruitment  efforts, 
especially  in  areas  such  as  New  York 
City  which  have  large  populations  of 
Boricua  Brothers  and  Sisters.  The  or- 
ganization has  not  neglected  the  great 
amount  of  work  needed  in  the  Boston 
area,  however,  and  has  participated  ac- 
tively in  health  and  hygiene  courses  in 
high  schools  in  the  Spanish-speaking 
community.  A  youth  guidance  program 
has  been  established  to  help  high 
school  students  realize  the  value  of 
higher  education  and  that  careers  in 
medicine  are  possible.  Each  medical 
student  takes  five  or  so  high  school 
students  as  tutees  and  gives  them  sup- 
port and  information  about  continued 
education  throughout  the  year. 

Two  other  organizations  that  have  also 
made  valuable  contributions  to  the 
Third  World  community  at  Harvard  are 


24 


the  Chicano  Health  Organization  and 
the  Native  American  Tribal  Council. 
The  CHO  has  been  involved  in  recruit- 
ment projects  and  was  instrumental  in 
the  establishment  of  a  medical  Spanish 
course  (outside  the  Medical  School) 
designed  to  increase  the  facility  with 
which  medical  students  or  other  in- 
terested medical  personnel  interact 
with  Spanish-speaking  patients.  One 
problem  which  the  CHO  has  faced  and 
fairly  effectively  dealt  with  has  been  a 
reluctance  on  the  part  of  many  Chicano 
students  recruited  to  come  to  the  East 
Coast  from  their  homes  in  the  Western 
states.  Most  of  the  students  who  have 
come  to  Harvard  have  expressed 
pleasure  at  finding  a  closely-knit  group 
into  which  they  could  fit  but  which  was 
still  flexible  enough  not  to  interfere  with 
their  other  activities  and  interests. 

But  of  all  the  student  organizations  at 
Harvard,  the  Native  American  Tribal 
Council  has  faced  probably  the  most 
difficult  problems.  Native  Americans 
have  been  more  poorly  represented  in 
the  health  profession  than  any  other 
ethnic  group  in  America  and  have  gen- 
erally received  some  of  the  poorest 
care.  Harvard  has  actively  sought  to  in- 
crease the  enrollment  of  Native  Ameri- 
cans throughout  the  University  and  in 
this  regard  the  NATC  has  been  crucial. 
It  has  played  a  major  role  in  recruitment 
and  counseling  of  undergraduate  stu- 
dents and  has  sought  to  interest  more 
students  in  careers  in  medicine.  Lobby- 
ing for  increased  financial  aid  and  more 
administrative  attention  to  specific  prob- 
lems faced  by  Native  Americans  at 
Harvard,  the  NATC  has  been  important 
in  insuring  that  the  students  who  have 
come  have  remained  in  school. 

Finally,  there  are  a  couple  of  national 
organizations  representing  Third  World 
students  that  have  active  chapters  at 
Harvard,  these  being  the  Student  Na- 
tional Dental  Association  and  the  Stu- 
dent National  Medical  Association.  In 
Cambridge  the  Harvard-Radcliffe 
Afro-American  Cultural  Center  has 
acted  as  a  focus  for  many  activities  at  a 
University-wide  level.  Participation  in 
any  of  these  organizations  is,  of  course, 
completely  voluntary,  and  anyone  may 
put  in  as  much  or  as  little  time  as  he  or 
she  pleases.  And  as  with  all  student 
groups,  you  find  some  people  who  are 
very  active  with  seemingly  boundless 
energy  while  others  choose  not  to  be- 
come involved  at  all. 


Although  the  problem  of  Third  World 
student  enrollment  at  HMS  has  been 
vigorously  and,  to  a  large  degree,  suc- 
cessfully attacked,  the  problem  of  Third 
World  faculty,  which  was  also  investi- 
gated by  the  Commission,  has  proven 
to  be  more  refractory  to  correction.  With 
two  exceptions,  no  medical  school  in 
the  United  States  has  a  large  or  rep- 
resentative Third  World  faculty.  Har- 
vard University  has  shown  a  great  deal 
of  reluctance  to  name  Third  World  peo- 
ple to  influential  and  particularly  to  ten- 
ured positions.  The  thin  excuse  that 
there  is  a  dearth  of  qualified  and/or  in- 
terested persons  available  is  growing 
more  untenable.  But  for  Harvard  there 
can  be  no  security  or  assurance  of  con- 
tinued enrollment  of  Third  World  stu- 
dents until  there  is  adequate  Third 
World  representation  at  the  decision- 
making levels  on  the  faculty  and  in  the 
administration.  Harvard  has  made  great 
strides  in  alleviating  and  correcting 
many  of  the  injustices  that  have  existed 
at  the  University  in  the  past,  but  it  goes 
without  saying  that  it  cannot  meet  com- 
pletely its  obligations  until  this  most 
difficult  problem  is  solved. 

Lastly,  there  are  people  who  might 
question  the  need  to  insure  that  Third 
World  students  remain  adequately  rep- 
resented at  Harvard.  Such  a  query  can 
be  answered  on  three  bases.  First,  and 


Chicanos 

by  Juan  Montes  '76 


most  obviously,  there  is  a  desperate 
shortage  of  Third  World  physicians  in 
this  country  today  which  can  be  cor- 
rected only  by  recruiting  actively  into 
medical  schools  and  properly  training 
as  many  members  of  this  group  as  pos- 
sible. Only  through  such  large-scale  ef- 
forts can  Third  World  people  be  res- 
cued from  poor  quality  medical  care. 
Second,  Third  World  patients  who 
come  onto  the  Harvard  Service  at  the 
teaching  hospitals  feel  less  intimidated 
and  more  relaxed  when  they  see  mem- 
bers of  their  own  ethnic  group  on  the 
medical  staff.  Often  a  Boricua.  Black,  or 
Chicano  medical  student  can  translate 
idioms  or  jargon  which  have  puzzled 
the  house  staff,  thus  improving  com- 
munication and  patient  care.  In  addi- 
tion. Third  World  students  tend  to  go 
out  of  their  way  to  insure  that  the  patient 
understands  the  nature  of  an  ailment, 
thus  breaking  down  some  of  the 
doctor-patient  cultural  barriers.  Third, 
before  the  coming  of  the  Third  World 
student,  the  Harvard  Medical  School 
was  an  incomplete  entity,  because  in  its 
purest  form  medicine  is  a  service  pro- 
fession. And  no  segment  of  that  profes- 
sion, whether  it  be  the  medical  school 
or  the  community  hospital,  or  the  teach- 
ing hospital,  can  be  accepted  as 
fulfilling  its  obligation  to  society  until  it 
represents  properly  all  members  of  that 
society. 


Juan  Montes  '76  expresses  the  difficulties  of  adapting  to  the  East  Coast  from  a  dif- 
ferent cultural  and  geographic  setting.  He  is  from  Santa  Paula.  California  and  at- 
tended UCLA. 


The  Northeast  could  not  be  further  re- 
moved from  all  that  is  indigenous  to  the 
Southwest.  One  finds  a  different  cli- 
mate, life  style,  and  people.  Conse- 
quently, there  are  few  Chicanos  in  New 
England.  The  few  permanent  Chicano 
residents  in  the  area  are  those  attracted 
by  employment  and  financial  security. 
Most  are  here  temporarily  as  students 
or  professionals  participating  in  educa- 
tional and  training  programs  and  return 
eventually  to  their  areas  of  origin.  This 
constant  flux  of  people  produces  an 
ever-changing  profile  of  the  Chicano 
population  in  Boston. 


Because  Boston  is  the  home  of  the  Pil- 
grims, the  Kennedys,  the  Old  North 
Church,  and  Harvard,  it  is  very  Anglo- 
Saxon.  There  is  no  pre-existing 
Chicano  identity  here  and  no  Chicano 
culture.  One  often  appears  naked  in 
this  environment  and  is  confronted  fre- 
quently with,  "Where  are  you  from?  or 
"What  nationality  are  you? "  To  answer 
this  question  necessitates  explaining 
one's  existence  and  requires  more  than 
a  simple  "I'm  a  Chicano. "  For  few  peo- 
ple in  the  area  know  what  a  Chicano  is 
But  to  ignore  such  a  question  leads  to 
confusion  and  misunderstanding. 


25 


To  aid  in  one's  perspective  at  Harvard 
are  other  Chicano  students.  Unfortu- 
nately, these  are  few  in  number.  The 
third  and  fourth-year  students  are  lost 
to  hospital  rotations.  Communication  is 
further  complicated  by  regional  differ- 
ences in  food,  language,  and  lifestyle 
among  the  Chicano  students  here 
which  can  breed  misunderstanding  and 
confusion.  To  prevent  antagonism  and 
separation,  it  often  helps  to  talk  of  one's 
experiences,  enabling  other  people  to 
learn  and  appreciate  them  in  the  con- 
text of  the  Chicano  awareness.  This 
often  leads  to  the  discovery  of  an  under- 
lying core  of  experience  and  a  bond 
among  the  Chicano  individuals. 

To  keep  one's  sense  of  reality  intact  in 
a  nonsupportive  environment  requires 
an  increased  emphasis  on  one's  cul- 
ture. Fellow  Chicano  students  are 
sought  out;  Chicano  music  is  played; 
Mexican  food  is  craved;  Spanish  is 
spoken;  and  "el  movimiento"  is  ideal. 
But  this  struggle  takes  much  effort,  and 
often  one  becomes  overwhelmed  by  a 
feeling  of  isolation  and  loneliness  and 
what  some  call  "culture  shock." 

For  the  Chicanos  at  HMS,  the  platform 
for  communication  has  been  a  local 
chapter  of  the  National  Chicano  Health 
Organization  (NCHO).  Through  this  or- 
ganization one  is  linked  with  the 
Southwest  and  La  Raza  (the  Chicano 
people),  but  it  also  serves  as  a  forum 
for  communication,  planning,  and  or- 
ganization for  the  Chicano  students 
here.  Due  to  the  lack  of  manpower, 
every  HMS  Chicano  should  participate 
in  activities  centered  around  recruiting, 
admissions,  and  the  Health  Careers 
Summer  Program  —  a  Harvard  pro- 
gram for  Third  World  students.  Other 
organizations  of  Chicano  concern  are 
Boston  Movimiento  Estudantil  Chicano 
de  Atzlan  (MECha),  which  derives  its 
membership  from  every  educational  in- 
stitution with  Chicano  student  enroll- 
ment, and  the  United  Farm  Workers 
Union  office,  a  strong  and  active  or- 
ganization. 

It  is  difficult  to  find  good  Mexican  food, 
much  less  good  Mexican  music,  out- 
side a  Chicano  residence.  There  are  a 
number  of  Mexican  restaurants  in  the 
Boston  area  that  are  both  hard  on  your 
palate  and  on  your  pocket.  The  most 
familiar  is  Casa  Mexico  in  Harvard 
Square;  others  include  Sol  Azteca  and 
Latin-O.  The  best  Mexican  restaurant  in 


the  area  with  the  most  authentic  at- 
mosphere and  music  is  Little  Mexico  in 
Manchester,  New  Hampshire,  a  res- 
taurant owned  by  Chicanos.  But  noth- 
ing beats  an  invitation  for  a  home- 
cooked  Mexican  dinner,  with  Mexican 
music  and  Chicano  friends. 

One  soon  realizes  that  the  price  for  a 
Harvard  medical  education  is  great  in 
terms  of  both  money  and  psychological 


hardships.  The  sacrifices  one  must 
make  include  separation  from  all  that  is 
familiar,  learning  to  cope  with  a  new 
environment,  and  continuous  self- 
assertion  and  struggle  to  preserve 
one's  identity  amidst  the  Harvard  glitter. 
At  Harvard,  one  endures,  survives,  and 
graduates.  And  it  becomes  apparent 
that  the  knowledge  of  where  one  came 
from  and  the  idea  of  where  one  is  going 
transcend  the  present  experience. 


Poor  Whites 

by  Harold  Bursztajn  '76 


Harold  Bursztajn  76  is  a  poor  white  whose  family  took  refuge  in  the  United  States 
from  Poland.  He  has  been  active  on  the  Harvard  Medical  School  Admissions 
Committee  and  in  Harvard's  Health  Careers  Summer  Program.  His  message  to 
alumni  is:  "Much  more  work  needs  to  be  done,  and  opportunities  are  available." 


The  disenfranchised  poor  of  this  nation 
often  feel  unable  to  make  their  prob- 
lems known  to  the  majority  of  the  mem- 
bers of  this  active  and  successful  soci- 
ety. In  spite  of  the  fact  that  social  con- 
sciousness regarding  the  problems  of 
minority  groups  has  reached  percepti- 
ble levels,  in  many  respects  the  health, 
educational,  and  economic  problems  of 
the  Poor  White  population  have  been 
neglected.  "Disadvantaged"  pre- 
supposes a  very  low  income  level.  This 
deprivation  is  reflected  in  lack  of  acces- 
sibility to  health  care  and  difficult  entry 
into  the  educational  system.  There  is 
increasing  acceptance,  even  by  some 
minority  groups,  that  these  criteria 
make  Poor  Whites  a  disadvantaged 
segment  of  our  society. 

Of  the  24  million  poor  people  in  the 
United  States,  16  million  (70%)  are 
"Poor  Whites."  It  is  true  that  in  this 
country  there  is  a  higher  proportion  of 
poor  minority  people  than  Poor  Whites. 
The  legitimate  claims  of  minority  groups 
should  never  be  diluted.  However,  the 
huge  demand  for  assistance  that  exists 
within  the  Poor  White  segment  of  our 
society  compels  us  to  consider  their 
needs.  The  point  is  that  if  a  person  in 
the  USA  is  poor,  he  or  she  is  probably  a 
Poor  White.1 

Despite  the  great  numbers  of  Poor 
Whites,  their  suffering  is  voiced  in 


muffled  tones.  They  have  been  slow  to 
identify  themselves  as  a  "societal  prob- 
lem." Some  Poor  Whites  are  reluctant 
to  admit  their  poverty.  And  some  who 
are  not  Poor  Whites  are  reluctant  to 
admit  that  Poor  Whites  exist.  The  resis- 
tance I  have  run  into  ranges  from, 
"What  do  you  mean  by  Poor  White?" 
to,  "If  you're  poor  and  white,  it's  be- 
cause you  re  stupid." 

The  nation's  social  consciousness  has 
been  raised  by  the  demands  of  Blacks, 
Chicanos,  Boricuas,  Native  Americans, 
and  other  minorities.  The  needs  have 
become  evident  for  improved  health 
care,  better  working  conditions,  more 
equitable  income  distribution,  and  in- 
creased educational  opportunities. 
These  needs  have  prompted  an 
awakened  and  increasing  interest 
among  Poor  Whites  with  regard  to  their 
own  cultural  and  socioeconomic  prob- 
lems. They  have  been  challenged 
either  to  accept  the  crippling  effect  of 
being  "disadvantaged"  or  to  reject  and 
overcome  their  poverty  and  its  hand- 
icaps by  increased  advocacy  for  social 
change.  They  must  put  up  or  shut  up. 

Harvard  Medical  School,  although  slow 
in  assuming  its  share  of  responsibility 
for  correcting  some  of  the  social  injus- 
tices, has  made  a  commitment  to 
balancing  its  student  population  with 
regard  to  minority  students  and  women. 


26 


In  the  class  entering  HMS  in  1 974,  ap- 
proximately 20%  are  minority  students, 
and  approximately  30%  are  women. 
The  Poor  White  Health  Organization 
has  petitioned  the  Medical  School  for 
increased  commitment  to  recruit  and 
admit  Poor  White  students.  With  the 
assistance  of  Dr.  A.  Stone  Freedberg, 
this  group  has  been  successful  in  get- 
ting a  few  Poor  Whites  admitted  to  the 
Harvard  University  Health  Careers 
Summer  Program  that  assists  them  in 
preparing  and  gaining  entrance  to 
health  career  educational  pathways.  In 
addition  to  recruitment,  Poor  Whites 
have  participated  in  the  admissions 
process  at  Harvard  Medical  School.  Al- 
though the  steps  are  small  and  halting, 
it  appears  that  Harvard  is  moving  slowly 
toward  an  acceptance  of  the  concept  of 
"disadvantaged"  as  an  economic,  so- 
cial, and  educational  problem,  not 
necessarily  a  racial  one.  Discrimina- 
tion and  disadvantage  are  more  than 
skin  deep. 

Some  Harvard  medical  students  have 
been  involved  in  improving  health  care 
in  the  surrounding  community.  In  the 
late  1960s,  HMS  students  joined  with  a 
group  of  people  from  the  adjacent, 
largely  Poor  White  community  of  "Mis- 
sion Hill"  to  obstruct  the  proposed  con- 
struction of  a  new  hospital  on  the  site  of 
the  present  Peter  Bent  Brigham  Hospi- 
tal. The  community  complained  that 
Harvard  was   elitist"  and  had  little  re- 
gard for  the  health  needs  of  the  com- 
munity it  served.  As  an  example,  the 
proposal  for  construction  of  the  new 
hospital  did  not  contain  plans  for  new 
outpatient  clinical  facilities.  These  poor 
people  expressed  a  distinct  dislike  for 
the  notion  that  Harvard  should  expand 
into  their  community  to  train  "leaders  in 
medicine,"  while  ignoring  neighborhood 
health  needs.  As  a  result,  the  revised 
proposal  for  the  Affiliated  Hospitals  con- 
tains some  outpatient  clinical  facilities 
and  begins  to  recognize  the  community 
demands  for  input. 

To  encourage  applications  from  Poor 
Whites  interested  in  the  health  care  pro- 
fessions, the  HMS  Admissions  Commit- 
tee provided  funds  for  members  of  the 
Poor  White  Health  Organization 
(PWHO)  to  recruit  in  Boston's  Mission 
Hill,  Appalachia,  Chicago,  and  Ne- 
braska during  the  spring  of  1973.  In  ad- 
dition, two  PWHO  members  served  on 
HMS  admissions  subcommittees  as 
advocates  for  applicants.  For  example. 


a  Poor  White  applicant  who  works  40 
hours  a  week  may  have  as  much  claim 
to  consideration  as  a  candidate  who 
has  no  need  to  work  and  manages  to 
amass  the  usual  amalgam  of  premed 
extracurricular  activities. 

The  system  within  which  we  live  has 
promulgated  the  irrational  as  the  rule. 
"Just  as  in  the  midst  of  life  we  are  in 
death,  so  in  the  midst  of  sanity  we  are  in 
insanity."2  However,  rational  things  are 
being  done  for  and  by  poor  people. 
Identify  with  this  struggle,  and  if  you 
say,  "Nobody  ever  listens  to  me!"  — 
that  is  because  you  are  speaking  too 
softly  for  them  to  hear. 


Footnotes: 

1    According  to  the  National  Commis- 
sion on  the  Financing  of  Post- 
Secondary  Education,   the  income  of 
families  of  youths  in  the  1 8-24  age 
group  divided  as  follows:  23%  are  at  the 
poverty  level,  below  S6.000;  almost 
58%  fall  into  the  56. 000-51 5,000 
bracket.  That  leaves  less  than  20%  of 
all  families  with  children  of  college  age 
at  51 5.000  and  above.    (From  Fred.  M. 
Hechinger,  "Class  War  Over  Tuition 
New  York  Times:  February  5,  1974 

2.   Ludwig  Wittgenstein.  Remarks  on 
the  Foundations  of  Mathematics. 


Native  Americans 

by  Janice  E.  Kulick  '76 


Janice  E.  Kulik  16  is  the  sole  native  american  in  the  Class  of  1976.  She  was  born 
on  the  Tuscarora  Reservation,  part  of  the  Iroquois  Nation,  near  Niagara  Falls.  New 
York  and  returns  to  visit  relatives  on  the  reservation  several  times  each  year. 


One  of  my  earliest  observations  as  a 
first-year  medical  student  was  that 
there  were  very  few  Native  Americans 
in  my  class.  In  fact,  there  was  but  one: 
me.  I  felt  alone,  as  any  medical  student 
does,  but  perhaps  at  times  even  more 
so,  because  I  didn't  fit  snugly  into  any 
predetermined  group.  In  many  areas  I 
identified  with  other  Third  World  stu- 
dents, and  I  joined  in  the  various  cam- 
paigns of  this  group.  But  while  we  dealt 
with  numerous  common  problems, 
there  were  still  many  facets  of  my  early 
medical  school  experience  which  were 
not  understood  by  my  classmates. 

But  wait  —  even  now  I  hear  people  say- 
ing —  "Native  American?  What  do  you 
mean  by  that?"  Basically,  a  Native 
American  is  anyone  of  at  least  one- 
quarter  or  more  "American  Indian" 
blood,  preferably  registered  on  a  tribal 
roll.  This  definition  implies  a  great  di- 
versity in  a  very  small  population.  The 
backgrounds  of  the  Native  Americans 
vary  from  those  who  have  lived  their  en- 
tire lives  on  a  reservation  to  those  who 
have  been  partially  assimilated  into  the 
culture  of  modern  United  States  soci- 
ety. As  a  result,  the  spectrum  of  prob- 


lems faced  by  Native  American  stu- 
dents ranges  from  those  faced  by  any 
medical  student  to  those  problems 
faced  by  other  members  of  the  Third 
World  student  population. 

The  Native  American  population  within 
the  Boston  community  is  greatest  in 
South  Boston,  where  the  Dorchester 
Native  American  Center  plays  an  or- 
ganizational role.  Other  projects  include 
the  Native  American  Clinic  at  the  Mas- 
sachusetts General  Hospital  —  located 
on  White  1 .  Harvard  University  sup- 
ports a  small  Native  American  Program 
and  also  maintains  the  Peabody 
Museum,  with  its  displays  of  Native 
American  history  and  culture.  Nation- 
ally, there  is  an  association  of  Native 
American  Medical  Students  that  is 
closely  aligned  with  the  Association  of 
Native  American  Physicians.  Both 
groups  work  toward  improving  the  level 
of  health  care  for  all  Native  Americans 

The  Native  American  at  Harvard  Medi- 
cal School  accepts  a  unique  responsi- 
bility for  the  medical  care  of  the  diverse 
Native  American  population 


27 


Part  IV  -  Coping 


Dr.  Fred  C.  Lane  (far  right),  Dean  of  Students,  hears  firsthand  reports  of  Internship  Matching 
Day  outcome. 


Dynamics  of 
Student-Faculty  Interaction 

by  David  W.  Nierenberg  '76 


David  W.  Nierenberg  76  has  shown  leadership  in  student-faculty  affairs.  This  past 
year,  he  was  co-chairperson  of  the  Student-Faculty  Committee.  He  has  worked 
hard  to  draft  legislation  protecting  the  confidentiality  of  student  records  and  to  or- 
ganize a  procedure  for  student  evaluations  of  basic  science  teaching. 


The  Student-Faculty  Committee  is  the 
"principal  representative  body  linking 
student  and  faculty  interests."  A  group 
of  about  30  faculty  members  and  stu- 
dent representatives  meets  every  other 
week  to  discuss  matters  of  common  in- 
terest. The  Committee  acts  as  an  ad- 
visory group,  communicating  its  rec- 
ommendations and  findings  to  the 
dean,  the  faculty,  or  the  appropriate 
standing  committee  of  the  faculty. 

The  dean  chooses  the  faculty  members 
who  serve  on  the  Committee  while  the 
students  represent  different  constituen- 
cies. Each  Medical  School  class  elects 
two  representatives,  while  each 
Harvard-MIT  class  sends  one  represen- 
tative. The  four  classes  of  the  Dental 
School  combine  to  send  two  represen- 
tatives. Several  of  the  student  groups 


(for  example.  Harvard  Medical  Area 
Women's  Group)  also  send  representa- 
tives. 

Each  year  the  Committee  considers 
major  issues  and  special  problems.  In 
the  past  year  the  Committee  funded 
student  organizations,  such  as  the 
Black  Health  Organization;  submitted  a 
recommendation  to  the  faculty  concern- 
ing the  confidentiality  of  student  rec- 
ords; put  forward  proposals  on  grading; 
and  studied  recent  trends  and  changes 
in  the  medical  curriculum.  The  Commit- 
tee has  launched  a  Faculty  Evaluation 
Project  in  an  effort  to  reward  superior 
teaching  in  the  Medical  School.  Most 
recently  the  Committee  met  with  Presi- 
dent Bok  and  Dean  Ebert  to  discuss  the 
role  of  teaching  in  the  tenure-granting 
process. 


In  short,  the  Student-Faculty  Commit- 
tee is  a  group  of  students  and  faculty 
members  who  try  to  propose  solutions 
to  common  problems.  That  this  Com- 
mittee has  the  widest  purview  of  all  the 
standing  faculty  committees  with  stu- 
dent representatives  is  both  its  greatest 
asset  and  its  greatest  weakness.  The 
interest  and  activity  shown  by  your 
class  will  help  determine  the  success  of 
the  Student-Faculty  Committee  in  the 
next  few  years. 

For  many  reasons,  "the  students"  and 
"the  faculty"  today  seem  to  view  each 
other  with  suspicion  and  sometimes 
open  hostility.  For  example,  many  stu- 
dents felt  that  "the  faculty"  was  out  to 
get  them  by  reinstituting  grades  or 
changing  the  curriculum  (although 
there  were  strong  arguments  made  on 
both  sides).  And  some  faculty  members 
were  annoyed  that  students  asked 
questions  during  class  (not  realizing 
that  students  today  are  likely  to  write 
fewer  notes  but  ask  more  questions). 

I  find  the  situation  much  like  a  tennis 
match,  where  "the  faculty"  and  "the 
students"  view  each  other  as  oppo- 
nents. Naturally,  each  side  is  out  to 
beat  the  other,  to  exploit  the  other's 
weaknesses,  and  to  force  the  opponent 
to  play  the  other's  game. 

The  spirit  that  prevails  when  two  tennis 
players  are  doubles  partners  is  lacking. 
In  that  situation,  each  player  realizes 
the  partner's  weaknesses.  But  instead 
of  exploiting  them,  one  tries  to  compen- 
sate, and  the  partnership  works  to- 
gether toward  a  common  goal. 

In  a  nutshell,  this  is  one  problem  at 
HMS.  The  faculty  and  students  do  not 
feel  themselves  as  equal  partners  work- 
ing toward  a  common  goal  —  providing 
each  medical  student  with  a  superior 
and  personalized  education. 

Although  neither  partner  is  to  blame  for 
this  state  of  affairs,  each  partner  could 
take  certain  steps  to  rebuild  a  more 
mutually  beneficial  relationship.  But  I 
will  focus  on  how  I  feel  an  incoming 
student  can  get  more  out  of  HMS. 

First,  get  to  know  your  instructors  bet- 
ter. Often  a  bad  lecturer  is  a  terrific  sec- 
tion leader.  In  contrast,  an  instructor 
may  be  unable  to  handle  a  section  of  24 
students  but  may  be  a  bnlhant  bed-side 
teacher.  The  only  way  to  find  out  is  to 


28 


get  to  know  your  instructors  better.  One 
of  the  best  ways  to  do  this  is  to  invite 
your  lecturer  or  section  leader  to  lunch 
or  dinner  at  Vanderbilt  Hall.  The 
Student-Faculty  Committee  will  pay  for 
this,  and  faculty  members  are  usually 
glad  to  avoid  eating  what's  in  their  lunch 
bags.  If  you  do  this  early  in  the  course, 
you  often  find  that  the  whole  tone  and 
direction  of  your  section  can  be  im- 
proved to  fit  your  interests  and  the 
teacher's  special  strengths. 

Second,  take  advantage  of  the  particu- 
lar strengths  of  each  faculty  member. 
I've  never  met  a  faculty  member  who 
doesn't  enjoy  talking  about  his  or  her 
specialty  or  showing  it  to  you.  In  the 
block  course  in  reproductive  biology, 
our  section  was  led  by  a  clinician  who 
was  a  bit  rusty  in  his  steroid 
metabolism.  But  the  highlight  of  the 
course  (not  included  in  the  syllabus) 
was  that  on  several  free  afternoons  we 
went  with  him  to  the  hospital  and 
watched  him  put  the  theory  into  prac- 
tice. This  man  was  a  superb  clinician 
who  made  the  course  syllabus  come 
alive. 

Finally,  on  an  individual  basis,  almost 
any  faculty  member  who  is  asked  will 
bend  over  backwards  to  help  a  student. 
If  you  don't  feel  that  you  are  getting 
enough  clinical  medicine  during  your 
first  year,  pick  out  a  clinician  whom  you 
respect  and  ask  if  you  can  follow  on  his 
or  her  rounds  one  afternoon  each 
week.  Chances  are  100  to  1  that  the 
faculty  member  will  say  "yes,"  and 
will  be  pleased  that  you  thought  enough 
to  ask. 

In  summary,  I  think  that  it's  time  that  we 
stopped  thinking  in  terms  of  "the  fac- 
ulty" and  "the  student"  as  if  they  were 
monolithic  superpowers  engaged  in  a 
fight  to  the  death  or  at  least  in  a  fight  to 
win  a  match,  6-0,  6-0.  If  we  as  students 
can  deal  with  each  faculty  member  on 
an  individual  basis,  and  if  the  faculty 
group  can  recognize  the  diversity  of  the 
students,  then  we  II  see  more  of  a  part- 
nership to  educate  good  physicians  and 
less  of  the  antagonism  which  seems  to 
have  developed  in  the  past. 

Recent  misunderstandings  have  un- 
derscored the  need  for  an  official  policy 
on  what  should  be  in  a  student's  per- 
manent record  and  who  should  be  al- 
lowed to  see  that  record.  As  a  result,  in 
the  spring  of  1 973,  the  dean  estab- 


lished a  special  committee  to  draw  up 
guidelines  for  an  official  policy  that 
would  satisfy  the  faculty,  administra- 
tion, internship  selection  committees, 
and  students. 

This  special  committee  was  a  joint  sub- 
committee of  the  Administrative  Board 
and  the  Student-Faculty  Committee.  Its 
recommendations  were  amended  and 
passed  by  both  parent  committees,  and 
at  press  time  the  final  draft  is  awaiting 
full  faculty  approval.  A  copy  of  the  final 
version,  which  is  now  the  official  policy 
at  HMS,  is  printed  below. 

An  academic  record  and  a  folder 
comprise  the  student's  whole  record. 
Each  medical  student  can  go  to  the 
registrar's  office  and  see  the 
academic  record,  consisting  of  official 
grades  and  comments.  Since  this  is  the 
bulk  of  a  student's  whole  record,  an  in- 
dividual actually  has  direct  access  to 
almost  everything. 

However,  material  in  the  folder  is  off- 
limits  to  students.  The  folder  contains 
confidential  communications  from  fac- 
ulty members  to  the  dean  or  registrar. 
Any  unsolicited  faculty  letters  about  a 
student,  either  positive  or  negative,  fit 
into  this  category.  Although  the  student 
cannot  read  these  letters,  one's  faculty 
advisor  can.  Thus  the  student,  by  dis- 
cussing matters  with  the  faculty  ad- 
visor, can  learn  indirectly  about  com- 
ments in  the  folder  and  thereby  benefit 
from  these  comments. 

Finally,  when  applying  for  first-year  res- 
idency or  internship  programs,  it  is 
Harvard's  policy  not  to  send  out  tran- 
scripts. Instead,  a  letter  of  evaluation  is 
written  by  the  student's  internship  ad- 
visor, amended  by  the  dean  of  stu- 
dents, and  sent  out  under  their  two  sig- 
natures. This  letter  is  meant  to  contain 
more  information  than  just  a  transcript 
and  should  be  a  better  evaluation  of  the 
student's  performance  while  at  HMS. 

Official  Policy  Statement  on 
Confidentiality  of  Students'  Records: 

There  are  two  types  of  records  kept  in 
the  registrar's  office:  (1 )  an  academic 
record  which  contains  the  transcript  of 
grades:  any  official  comments  concern- 
ing performance  submitted  with  the 
grades:  and  the  internship  letter  and  (2) 
a  "folder"  which  contains  miscella- 
neous official  correspondence:  other 


material  such  as  recommendations 
written  on  the  student  s  behalf  by  mem- 
bers of  the  administrative  staff  and  fac- 
ulty: the  original  application  for  admis- 
sion; official  actions  of  the  appropriate 
academic  boards  of  the  school;  and 
other  correspondence  not  of  a  medical 
or  health  nature.  Medical  and  health 
records  are  not  kept  in  the  registrar  s 
office.  An  official  Medical  School  tran- 
script contains  only  grades.  The  Joint 
Administrative  Board-Student-Faculty 
Committee  recommends: 

(A)  Only  the  dean  of  the  Medical 
School,  the  student  affairs  office, 
the  registrars  office,  the  preclinical 
promotions  board,  the  preclinical 
advisory  board,  the  appeals 
board,  the  clinical  review  board, 
the  examinations  committee,  the 
curriculum  advisor,  the  internship 
advisor  and  the  student  should 
have  access  to  the  academic  rec- 
ord as  kept  in  the  registrar's  office. 

(B)  Individual  faculty  members  who 
are  asked  by  a  student  to  write  let- 
ters of  recommendation  on  the 
student's  behalf  should  not  have 
access  to  the  academic  record  un- 
less the  student,  in  writing,  re- 
quests the  registar's  office  to  pro- 
vide that  information. 

(C)  It  has  been  Harvard  Medical 
School's  policy  not  to  provide 
material  from  the  academic  record 
to  hospitals  as  part  of  the  recom- 
mendation for  the  first-year  post- 
graduate training.  If  an  individual 
student  wishes  a  hospital  to  re- 
ceive the  transcript  and  official 
comments  from  the  academic  rec- 
ord, he  should  notify  the  registrar's 
office  in  writing. 

(D)  The  academic  record  or  folder  may 
only  be  released  to  appropriate 
persons  external  to  the  school  on 
written  permission  of  either  the 
student  or  the  graduate. 

(E)  Only  the  dean  of  the  Medical 
School,  the  student  affairs  office, 
and  the  curriculum  and  internship 
advisor  should  have  access  to  the 
folder.  The  appropriate  academic 
boards  of  the  school,  if  necessary, 
can  request  specific  additional  in- 
formation from  the  folder  to  aid  in 
their  deliberations. 

(F)  The  material  contained  m  the  folder 
shall  be  conveyed  to  the  student  at 


29 


the  discretion  of  his  advisor  to 
further  the  education  and  general 
welfare  of  the  student. 

With  the  hope  that  the  quality  of  teach- 
ing at  HMS  would  improve  if  there  were 
some  way  to  reward  good  instructors, 
the  Student-Faculty  Committee  began 
a  Faculty  Evaluation  Project  several 
years  ago.  The  plan  is  for  the  two 
Student-Faculty  Committee  representa- 
tives from  each  class  to  distribute  an 
evaluation  form  at  the  end  of  each 
course  for  students  to  evaluate  their 
lecturers  and  section  leaders.  These 


are  then  collected  and  summarized. 

The  final  evaluations  are  sent  to  each 
course  chairman  to  help  him  determine 
how  well  the  students  received  the 
course  instructors  and  to  help  plan  the 
teaching  assignments  for  the  following 
year.  We  also  encourage  the  course 
chairman  to  convey  the  results  to  the 
individual  instructors.  This  is  the  only 
form  of  constructive  feedback  that  an 
instructor  normally  receives. 

Finally,  at  the  end  of  each  year,  based 
on  the  evaluations,  the  three  best 
teachers  in  each  course  are  selected. 


They  are  notified,  and  letters  are  sent  to 
their  department  chairmen  and  the  var- 
ious promotions  boards.  Hopefully,  this 
will  put  the  spotlight  on  the  very  best 
lecturers  and  section  leaders. 

The  Class  of  1 976  was  the  first  to  carry 
out  this  project  completely.  As  a  result 
of  their  work  and  the  cooperation  of  the 
various  course  chairmen,  the  teaching 
in  some  of  the  courses  was  much  im- 
proved for  the  Class  of  1 977.  We  hope 
that  future  classes  will  continue  to  carry 
on  this  project,  as  the  results  benefit 
both  instructors  and  students. 


The  Student  Liasion  Committee 

by  Leslie  M.  Greenberg  '77 


Leslie  M.  Greenberg  77,  having  finished  the  first  year  of  Harvard  Medical  School, 
is  sensitive  to  the  problems  of  coping  while  an  undergraduate.  To  make  the  transi- 
tion to  medical  school  easier  for  incoming  students,  he  has  been  the  main  force  be- 
hind the  new  Student  Liaison  Committee.  He  would  like  to  hear  from  alumni  in- 
terested in  working  with  this  new  committee. 


Harvard  Medical  School  is  a  large, 
complex  institution.  An  applicant  is 
greeted  only  by  a  foreboding  gray 
quadrangle  with  the  words  "Harvard 
Medical  School"  carved  in  marble 
above  Building  A.  If  the  applicant  has 
the  misfortune  to  arrive  on  a  gray,  rainy 
day,  he  or  she  may  well  find  the  Quad- 
rangle completely  deserted,  as  I  did.  In 
the  past,  students  have  arrived  for  their 
interviews  only  to  learn  that  Mas- 
sachusetts General  Hospital  is  on  the 
other  side  of  town  and  that  they  have 
five  minutes  to  get  there.  In  their  haste 
not  to  be  late,  their  impression  of  HMS 
is  a  quick  view  of  the  Quad. 

Harvard  Medical  School  is  much  more 
than  a  gray  Quad  or  a  busy  corridor  in  a 
hospital.  HMS  is  people,  experiences, 
and  attitudes.  In  the  past  year  many 
people  have  been  trying  to  increase  the 
information  flow  about  and  within  HMS. 

The  Student  Liaison  Committee  is  a 
group  of  interested  students  who  have 
been  working  to  make  life  within  the 
Medical  School  a  more  valuable  ex- 
perience by  trying  to  increase  informa- 
tion flow  and  to  provide  the  chance  for 
interactions  among  students,  appli- 
cants, and  alumni.  We  believe  that 


each  group  should  have  the  opportunity 
to  benefit  from  the  experiences  of  their 
predecessors  instead  of  having  to  suf- 
fer the  same  problems  in  a  vacuum. 

The  Student  Liaison  Committee  (SLC) 
is  in  the  process  of  setting  up  a  program 
whereby  applicants  coming  to  the 
school  will  have  the  opportunity  to 
speak  to  current  students  and  to  see 
more  of  the  school.  We  feel  that,  in  this 
way,  the  applicant  will  have  more  in- 
formation on  which  to  base  a  decision. 

When  a  student  arrives  at  HMS  to  begin 
the  first  year,  he  or  she  is  faced  with  a 
whole  new  environment.  If  the  student 
can  turn  to  someone  and  ask  ques- 
tions, it  makes  life  a  bit  easier.  The  SLC 
is  setting  up  a  program  in  which  each 
first-year  student  has  an  upperclass 
"advisor,"  along  the  lines  of  a  big 
brother-big  sister  program.  This  upper- 
class  advisor  can  help  the  first-year 
student  cope  with  the  problems  of  ad- 
justing to  a  new  lifestyle  and  environ- 
ment. The  problem  may  be  merely 
finding  a  good  place  to  eat  on 
weekends  or  buying  the  best  book  to 
use  for  a  certain  course.  If  the  student 
has  problems  that  the  advisor  is  un- 
equipped to  handle,  the  advisor  still  has 


more  experience  with  the  HMS  struc- 
ture and  can  refer  the  first-year  student 
to  the  proper  person  or  office.  Second, 
third,  and  fourth-year  students  will 
serve  as  advisors,  show  applicants 
around,  and  talk  to  them.  First-year 
students  are  invited  to  help  show  ap- 
plicants around  and  to  speak  to  them 
after  they  have  had  a  few  months  to  get 
oriented  themselves. 

Students  at  HMS  are  exposed  predom- 
inantly to  academic  physicians.  The 
SLC  feels  that,  while  this  is  very  valu- 
able, students  should  have  the  oppor- 
tunity to  meet  and  spend  time  with 
physicians  in  other  types  of  practices  to 
provide  alternative  role-models.  The 
SLC,  in  cooperation  with  the  HMS 
alumni  office,  is  organizing  a  program  in 
which  students  can  spend  a  day  or  a 
weekend  with  an  HMS  alumnus/alumna 
in  private  practice.  Students  in  all  four 
classes  are  invited  to  participate  in  the 
alumni  program. 

The  SLC  is  presently  funded  by  the 
student  affairs  office  and  is  a  student 
organized,  student  run,  voluntary 
group.  No  information  regarding  appli- 
cants who  come  for  interviews  and  are 
shown  around  by  students  will  be 
transmitted  to  the  admissions  commit- 
tee. This  new  program  is  strictly  for  the 
benefit  of  the  applicants.  The  Student 
Liaison  Committee  is  endorsed  by  the 
HMS  Admissions  Committee  and  the 
Student-Faculty  Committee 


30 


Portrait  of  an  HMS  I 

by  Paul  C.  Shellito  '77 


Paul  C.  Shellito  77  writes  a  frank  autobiographical  article  about  his  difficulties  in 
adjusting  to  Harvard  Medical  School.  While  none  of  us  can  identify  with  everything 
Paul  Shellito  describes,  we  can  identify  with  certain  anxiety-provoking  aspects  of 
HMS,  whether  they  be  academic,  cultural,  or  social. 


When  warm  weather  returned  to  Bos- 
ton in  the  spring,  I  began  to  realize  how 
much  I  had  learned  and  experienced 
during  my  first  year  at  Harvard  Medical 
School.  In  the  spring  the  physical  set- 
ting reverted  to  what  it  had  been 
when  I  first  arrived.  Just  as  old  re- 
cordings occasionally  heard  on  the 
radio  can  instantaneously  transport  the 
memory  (or  indeed,  one's  whole  being 
it  seems)  back  to,  say,  that  incredible 
summer  before  a  senior  year  in  high 
school,  so  the  sights  and  smells  around 
HMS,  particularly  in  Vanderbilt  Hall, 
began  to  mingle  in  an  old  way  that  I  had 
forgotten  over  the  winter.  While  that 
flashback  lingered,  I  was  capable  of 
perceiving  my  initial  feelings  again.  But 
now  there  is  a  new  light,  of  course, 
since  I  can  compare  that  situation  with 
the  present  one.  It  allows  me  to  sym- 
pathize with  myself  a  bit  and  to  ap- 
preciate which  of  my  thoughts  at  the 
time  were  relatively  valid  as  well  as  the 
immense  amount  of  development  that  a 
first  year  student  can  undergo. 

My  personal  experience  began  with 
growing  up  and  going  to  college  in  the 
Midwest.  Although  I  had  visited  the 
East  Coast  a  number  of  times,  I  had 
never  lived  there  or  seen  Boston.  In  ad- 
dition, I  had  almost  no  previous  infor- 
mation about  the  academic  program  at 
HMS,  and  of  course  none  of  the  more 
informal  characterizations  of  the  Medi- 
cal School  was  able  to  reach  me.  My 
initial  thoughts  were,  in  part,  composed 
of  the  anticipation  of  living  in  a  possibly 
exciting  city.  In  spite  of  the  fact  that  liv- 
ing in  a  metropolitan  area  was  some- 
thing that  would  be  quite  new  to  me,  I 
was  anxious  to  experience  some  of  the 
brighter  aspects  of  Boston,  such  as  the 
museums,  concerts,  and  historical 
areas,  and  for  the  most  part  this  over- 


shadowed any  negative  feelings  that  I 
had  about  living  there.  Other  prelimi- 
nary thoughts  or  apprehensions  I  had 
about  attending  Harvard  Medical 
School  involved  the  academic  aspect.  It 
was  obvious  that  for  the  first  time, 
everyone  in  my  class  would  be  consid- 
erably accomplished.  Although  this 
certainly  would  be  advantageous,  I 
knew  that  my  academic  performance  in 
classes,  relative  to  the  rest  of  the  stu- 
dents, would  not  be  as  before.  This 
didn't  really  seem  very  crucial,  how- 
ever, because  as  far  as  I  was  con- 
cerned, admission  to  Harvard  Medical 
School  meant  that  I  was  almost  as- 
sured of  receiving  a  good  education 
and  an  M.D.  In  addition,  I  considered 
the  likelihood  of  having  much  less  free 
time  than  before.  My  senior  year  in  col- 
lege and  the  following  summer  were 
great  times  for  me,  and  I  wasn't  sure  if  I 
would  be  very  happy  about  having  to 
spend  all  of  my  time  studying  again. 

When  I  arrived  in  Boston,  I  had  a  few 
days  to  relax  before  classes  com- 
menced. Since  an  old  college  friend 
was  living  in  Boston  then,  I  had  a  com- 
panion with  whom  I  began  to  enjoy  the 
finer  aspects  of  the  city  that  I  had  been 
anticipating.  My  summer  fantasies 
coincided  very  nicely  with  what  I  was 
now  experiencing.  When  I  started 
classes,  however,  I  suddenly  found  my- 
self among  total  strangers,  a  little  at  a 
loss  for  making  friends.  I  had  never 
lived  in  a  dormitory  before,  and  I  had 
never  been  thrust  in  with  so  many  new 
people  whom  I  felt  I  needed  to  get  to 
know.  Also,  I  simply  had  trouble  (as 
perhaps  a  lot  of  people  did)  ending  my 
undergraduate  life,  and  suddenly  be- 
coming a  member  of  HMS  I.  This  was 
particularly  true  because  in  college  I 
had  what  I  thought  was  the  best  time  of 


my  life,  and  I  had  parted  with  some  very 
close  friends  there.  As  a  result  of  this 
and  of  the  slight  inability  to  make  ac- 
quaintances, I  think  perhaps  that  I 
lagged  a  little  —  not  being  able  to 
accommodate  myself  completely  to 
dormitory  life  or  making  new  friends. 

For  a  while  I  was  a  bit  lonely,  and  that, 
coupled  with  the  new  restrictions  on  my 
time,  meant  that  at  first  I  didn  t  have 
much  in  particular  to  look  forward  to 
from  day  to  day,  which  was  sometimes 
slightly  depressing.  This  situation  could 
hardly  help  changing,  as  I  was  eating  all 
my  meals  and  going  to  most  of  my 
classes  with  the  same  individuals  each 
day.  It  seems  now  that  it  was  more  due 
to  the  action  of  a  few  other  warm- 
hearted people  that  I  began  to  make 
some  friends.  In  addition,  parties  in 
Vanderbilt  Hall  as  well  as  some  infor- 
mal get-togethers  helped  me  feel  much 
less  alone.  One  of  the  great  assets  of  a 
Harvard  Medical  School  class,  I  think,  is 
the  fact  that  the  admissions  process  not 
only  brings  together  those  who  are 
competent  intellectually  but  it  also,  for 
the  most  part,  selects  people  who  are 
more  than  just  good  students.  I  enjoyed 
getting  to  know  my  classmates  be- 
cause most  seemed  to  possess  a  de- 
lightful array  of  outside  abilities  and  in- 
terests. Even  more  pleasant  was  the 
discovery  that  there  were  students  in 
my  class  and  in  those  ahead  of  mine 
who  were  willing  to  put  out  more  than 
their  share  of  kindness. 

Outside  of  the  classroom  and  the  dor- 
mitory there  were  more  adjustments 
and  discoveries.  As  I  suggested  above, 
I  wasn't  certain  if  life  in  a  city  like  Boston 
would  appeal  to  me  in  the  long  run. 
That  suspicion  is  probably  still  with  me. 
Boston  was  most  likely  more  of  a  cul- 
ture shock  to  me  than  to  most  of  HMS  I 
because  of  my  previous  experiences 
and  background.  I  came  biased  with  an 
affection  for  the  long  open  spaces,  and 
I  never  before  had  to  worry  about  get- 
ting gasoline  or  getting  mugged.  These 
facts,  coupled  with  the  pollution  and  the 
confinement  in  such  a  city,  became 
pretty  meaningful  to  me.  For  a  while, 
Boston's  advantages  no  longer  so  ef- 
fectively outweighed  the  less  agreeable 
aspects.  However,  I  had  to  look  upon 
the  matter  as  a  desirable  learning  ex- 
perience, since  that  was  part  of  the 
reason  I  had  come  to  HMS.  I  never 
regretted  coming  to  Boston,  but  it  was 
a  change.  In  spite  of  the  task  of  ac- 


31 


commodating  myself  to  living  in  Boston, 
I  wasn't  disappointed  in  the  things  that  I 
had  looked  forward  to  before  I  arrived. 
People  in  my  class  who  weren't  so  new 
to  the  area  helped  introduce  me  to  a  lot 
of  good  times  in  Cambridge  and  else- 
where. The  museums  were  everything 
that  I  had  expected,  and  I  was  able  to 
attend  the  Boston  Symphony  Orchestra 
concerts  regularly.  In  fact,  it  was  during 
one  of  the  BSO's  first  concerts,  early  in 
the  fall,  that  I'm  sure  I  felt  an  initial  con- 
tentment about  being  in  Boston.  What  I 
had  to  learn  in  discovering  the  city  was 
that  it  was  more  than  merely  the  crime, 
the  garbage,  and  the  extra  hassles  — 
that  the  beauty  was  of  a  kind  different 
from  what  I  had  been  accustomed  to. 
The  same  thing  was  true,  I  found,  of  the 
East  Coast  in  general.  I  had  the  oppor- 
tunity to  visit  New  Hampshire  a  number 
of  times  only  to  discover  that,  even 
there,  the  density  of  people  was  more 
than  I  expected. 

The  classroom  experience  itself  at  Har- 
vard Medical  School  varied  a  great  deal 
during  the  first  year.  It  was  certainly  one 
of  my  chief  concerns  and,  at  times,  dis- 
appointments. Often,  I  wasn't  happy 
with  much  of  the  teaching  that  I  re- 
ceived in  the  first  semester.  I  was 
aware  that  the  institution  had  a  lot  of 
other  important  things  with  which  to  oc- 
cupy itself  besides  the  instruction  of 
first-year  students,  but  the  level  of 
teaching  and  organization  so  often  evi- 
dent during  those  months  made  me  feel 
as  if  beginning  medical  students  were 
rather  incidental,  as  far  as  the  rest  of 
the  school  was  concerned.  There  were 
times  when  lectures  seemed  astonish- 
ingly poor,  especially  in  comparison  to 
what  I  had  expected.  The  condition  did 
not  arise  from  any  lack  of  knowledge  or 
integrity  of  our  instructors,  but  it  was  in- 
stead probably  because  of  a  lack  of  or- 
ganization, appreciation  of  the  stu- 
dents' level  of  knowledge,  and  actual 
individual  teaching  skills.  There  were, 
to  be  sure,  very  notable  exceptions  to 
this,  but  my  disappointment  arose  from 
the  mistaken  expectation  that  unneces- 
sarily confusing  and  frustrating  classes 
would  be  rare  occurrences. 

Another  disturbing  situation  was  the 
quality  of  student-faculty  relations  dur- 
ing that  first  semester.  In  the  fall,  the 
majority  of  our  class  expressed  its  dis- 
like for  the  four-tier  grading  system  then 
in  effect.  Unfortunately,  although  not 
completely  unexpectedly,  this  evoked 


animosity  from  many  faculty  members 
(as  it  had  among  numerous  students). 
For  a  while  the  situation  caused  some 
friction,  and  although  the  issue  seemed 
valid  to  me,  I  was  discouraged  some- 
what by  the  way  in  which  students  and 
faculty  were  reacting  to  each  other  and 
by  surprising  threats  from  important 
faculty  members.  I  felt  that  perhaps  in 
general  we  should  be  working  more 
with  one  another  —  even  enjoying  one 
another.  Luckily,  the  academic  situation 
began  to  improve  during  the  following 
semester.  This  also  may  have  been 
partially  because  of  the  fact  that  I  was 
simply  becoming  accustomed  to  Har- 
vard Medical  School.  But  I  am  sure  that 
our  classes  and  our  teaching  began  to 
change  for  the  better  as  well,  and  I  felt 
that  there  was  in  general  more  organi- 
zation and  more  appreciation  by  the  in- 
structors of  the  students.  I  still  affirm  my 
initial  complaints  about  many  of  the  first 
semester  courses.  Perhaps  I'll  always 
recall  that  lengthy  finals  period  in  De- 
cember as  the  culmination  of  a  learning 
period  that  was  sometimes  consider- 


ably less  than  pleasant.  In  addition,  al- 
though the  warnings  of  upperclassmen 
and  some  faculty  members  implied  that 
after  the  first  semester  classes  would 
really  begin  to  get  tough,  I  definitely  felt 
more  at  ease  with  the  courses  and 
satisfied  with  the  instruction,  as  well  as 
with  what  I  was  learning,  during  the 
second  half  of  the  year. 

I  think  that  perhaps  all  these  impres- 
sions will  dart  instantly  and  vividly 
through  my  mind  whenever  I  catch 
those  familiar  sights  and  smells  around 
the  Quadrangle,  long  after  I'm  gone 
from  room  347,  Vanderbilt  Hall.  They 
will  always  remind  me  of  the  unex- 
pected, abundant,  but  often  subtle  ex- 
periences that  a  first-year  student  can 
have  at  Harvard  Medical  School.  In 
spite  of  several  drawbacks,  I  have,  with- 
out a  doubt,  been  happy  that  I  came 
here.  Much  of  the  instruction  did  im- 
prove during  the  year,  as  relations  with 
classmates  as  well  as  East  Coast  liv- 
ing became  more  and  more  gratifying. 


Marriage  to  a  Female  HMSer 

by  Bradley  E.  Alger 

/  thought  that  Perspectives  should  acknowledge  the  increasing  number  of  medical 
student  husbands,  who  will  eventually  succeed  in  destroying  old-fashioned 
stereotypes.  Bradley  E.  Alger,  a  graduate  student  in  psychology  at  Harvard,  is 
married  to  Lindsay  Staubus  Alger,  a  third-year  medical  student. 


Having  a  wife  who  is  a  medical  student 
is  a  situation  commonly  fraught  with 
difficulties,  or  so  I  am  assured  from  time 
to  time.  And  from  that  point  of  view,  I 
may  not  be  well  qualified  to  write  this 
essay,  being  in  the  atypical  position, 
thus  far,  of  taking  more  pleasure  than 
pain  in  my  wife's  vocation.  "Thus  far" 
because  she  has  only  finished  her  sec- 
ond year,  and,  again  I  am  assured,  the 
third  year  is  the  worst. 

Of  the  distinctive  concerns  of  non- 
medical husbands  with  medical  wives, 
the  first  that  comes  to  mind  (assuming, 
naturally,  that  you  have  already  assimi- 
lated the  idea  that  no  would-be  doctor 
spends  all  her  time  frantically  cleaning 
house,  preparing  meals,  or  in  general 


hovering  about,  attentive  to  her 
husband  s  every  beck)  has  to  do  with 
the  Harvard  Medical  School  surround. 
The  environment  in  which  HMS  is 
situated  is  not  uniformly  reassuring  to 
one  accustomed  to  having  his  wife  work 
late  at  school,  even  to  one  used  to  see- 
ing her  return  home  safely.  The  city  is 
the  source  of  all  the  wonderful  clinical 
experience  for  which  Harvard  is  noted 
and,  partly  therefore,  is  no  place  in 
which  women  should  walk  at  night. 

Because  Lindsay  is  going  to  be  a  doc- 
tor, we  have  been  forced  to  consider, 
with  alarming  seriousness  at  times, 
questions  concerned  with  having  chil- 
dren. It  is  alarming  in  the  sense  that, 
despite  the  fact  that  neither  of  us  wants 


32 


children  for  several  years,  we  do  plan  to 
have  them,  and  decisions  in  the  rela- 
tively near  future  will  have  to  be  made 
with  them  in  mind.  "When"  is  a  major 
topic.  It  is  interesting  to  learn  that  vari- 
ous statistics  conspire  to  make  a 
woman's  bearing  children  before  age 
30  seem  desirable.  But  "when"  is  also 
constrained  by  a  whole  slew  of  factors, 
many  of  which  are  related  to  the  struc- 
ture of  medical  education  and  practice 
in  this  country.  More  opportunities  for 
part-time  programs  and  types  of  group 
practice  would  be  helpful  in  allowing 
doctors  to  take  part  in  the  rearing  of 
their  offspring.  Such  programs  probably 
would  require  more  medical  schools 
and  more  doctors;  the  necessary 
changes  will  not  be  easy.  In  any  case, 
two  matters  even  more  fundamental 
than  AMA  politics  are  involved.  The  first 
is  the  particular  one  of  which  specialty 
to  pursue,  some  being  more  consonant 
with  having  a  family  than  others.  The 
second  is  the  general  one  of  what  style 
of  physician  to  be,  of  what  sorts  of  goals 
to  strive  for.  That  is,  my  wife,  originally  a 
normal,  competitive,  pre-med  type  per- 
son, occasionally  has  a  desire  to  try  to 
scramble  up  the  heap  to  become  Chief 
Doctor  of  the  Western  Hemisphere,  or  a 
similar  exalted  rank.  She  also  wants  to 
have  a  hand  in  raising  children  and  in 
fact,  other  things  being  equal,  would 
like  to  follow  a  path  that  would  allow  her 
to  maintain  an  interesting,  challenging 
career  and  to  have  a  family.  It  is  not 
clear  that  this  is  always  possible.  Yet  it 
seems  to  be  true  that  the  problem  is  of 
immediate  interest  since  grades,  loca- 
tions of  clerkships,  and  research  are  all 
important  for  the  ambitious. 

Returning  to  the  homier  issues  of  day- 
to-day  living,  there  is  the  unique 
schedule  of  medical  school  courses. 
Because  I  am  also  a  student,  my  time 
off  is  as  limited  as  my  wife's.  What  is 
difficult  is  that  we  are  almost  never  off 
at  the  same  time.  If  I  have  just  finished 
a  set  of  exams,  it  is  certain  that  she  is 
just  beginning  one.  This  inability  to 
enjoy  our  brief  vacations  together  was  a 
prime  annoyance  during  the  first  year. 

Nights  away  from  home  are  supposed 
to  make  some  clerkships  especially 
desolate  periods,  and  there  is  no 
reason  to  doubt  this  will  be  so.  It  is  un- 
deniable that  at  times  the  tensions  of 
medical  school  have  interfered  with  our 
sex  life.  Since  puberty,  many  things 
have  interfered  with  my  sex  life.  There- 


fore, surviving  these  interruptions 
should  be  possible,  but  it  is  not  a  time 
to  which  one  looks  forward  eagerly. 

Nights  away  from  home,  incidentally, 
will  be  made  doubly  desolate  for  some 
by  the  thought  of  the  plethora  of  male 
students,  interns,  etc.,  all  staying  the 
night  where  married  female  students 
are  also  staying  the  night.  Indeed,  med- 
ical school  in  general  is  not  constituted 
to  give  peace  of  mind  to  a  husband  with 
any  leanings  toward  jealousy.  There  is 
a  three-to-one  male-female  ratio,  and 
that  means  every  woman  receives  her 
share  of  attention.  Presumably  the 
first-year  marriage  boom  relieves  some 
of  the  pressures,  but  it  is  always  possi- 
ble to  hear  stories. 

In  the  real  world  a  disparate  male- 
female  ratio  frequently  has  implications 
regarding  discrimination  based  on  sex. 
And,  while  for  the  most  part  the  Harvard 
medical  community  doesn't  do  too  bad 
a  job,  still,  for  the  record,  I  would  like  to 
take  this  opportunity  to  wonder  whether 
it  is  true  that  for  certain  clerkships  there 
are  no  adequate  separate  sleeping 
quarters  for  women  and  that  for  others 
the  dressing  facilities  are  of  inferior 
quality.  And,  of  course,  if  so,  why? 


A  final  nuance  of  married  life  with  a 
woman  medical  student  evinces  itself  at 
parties.  I  am  proud  that  Lindsay  is  going 
to  become  a  doctor  and  furthermore 
have  no  trouble  admitting  that  she  goes 
to  Harvard.  As  a  result,  there  is  a  par- 
ticular awkwardness  when  we  meet  the 
wives  of  some  of  my  friends,  those 
whose  occupation  is  unglamorous  and 
who  feel  the  worse  for  an  implicit  com- 
parison. It  is  a  peculiarly  ambiguous 
position  for  me  to  be  in  because  cour- 
tesy to  them  seems  to  demand  de- 
emphasizing  the  pleasure  I  take  in  my 
wife  s  achievements,  while,  at  the  same 
time,  it  is  not  fair  to  Lindsay  to  pretend 
for  appearance  s  sake  that  she  is  just 
another  wife  with  just  another  job. 

In  fact,  life  in  general  does  not  live  like 
just  another  life.  It  is  busy,  interesting, 
and  enjoyable.  The  hardships  are  offset 
by  benefits,  God  is  in  His  Heaven,  and 
all  is  as  right  as  can  reasonably  be  ex- 
pected at  this  point.  I  could  not  be 
happy  with  someone  who  did  not  have 
her  own  serious  interests,  some  job  of 
her  own  to  carry  out  which  preferably 
has  nothing  to  do  with  me.  I  consider 
myself  lucky  to  have  found  someone  to 
love  who  is  like  that. 


A  View  from  the  Couch 

by  Samuel  Bojar,  M.D. 

Samuel  Bojar,  M.D.,  psychiatrist  to  the  Medical  Area  Health  Service,  has  helped 
thousands  of  students  cope  with  the  demands  of  medical  school.  He  is  an  exceed- 
ingly popular  physician  who  always  eats  lunch  in  Vanderbilt  Hall  and  who  will  al- 
ways make  time  to  see  the  student  who  has  suddenly  plummeted  into  a  crisis. 
Everyone  I  know  who  has  received  counseling  from  Dr.  Bojar  has  been  grateful. 


Before  coming  to  Medical  School  you 
undoubtedly  heard  all  sorts  of  com- 
ments about  how  hard  the  work  would 
be,  the  long  hours  you  would  spend 
studying,  the  dangerous  exposure  to 
disease,  and  similar  truths,  halftruths. 
and  myths.  Whatever  you  may  have 
heard,  however,  you  may  rest  assured 
that  by  virtue  of  being  a  medical  student 
you  are  not  any  more  susceptible  to 
disease,  nor  are  you  granted  any  par- 
ticular immunities.  Should  you,  how- 
ever, develop  any  medical  problems, 
be  they  physical  or  emotional,  the  Med- 
ical Health  Service  stands  ready  to  help 
you.  This  prepaid  plan  provides  com- 


prehensive diagnostic,  therapeutic,  and 
preventive  medical  care. 

The  Medical  Area  Health  Service  is  a 
unit  of  the  Harvard  University  Health 
Services.  The  service  is  staffed  by  male 
and  female  physicians  who  offer  medi- 
cal and  gynecological  care,  a  psychia- 
trist, a  technician-medical  assistant,  and 
secretaries  who  are  responsive  to  your 
requests  for  medical  attention 
Surgeons  and  other  specialists  are 
available  for  consultation  Dr.  James  J 
Feeney  is  the  Director  of  the  Medical 
Area  Health  Services,  and  Dr  Samuel 
Bojar  is  the  psychiatrist 


33 


The  Health  Service  has  a  policy  of 
wanting  to  know  the  student  population, 
and  each  member  on  entering  HMS 
and  Harvard  School  of  Dental  Medicine 
classes  is  given  an  appointment  for  a 
physical  examination  and  a  personal  in- 
terview. These  give  you  the  opportunity 
to  get  to  know  the  doctors  to  whom  you 
can  turn  for  medical  and  emotional 
help,  personal  counseling,  and  advice. 

The  members  of  the  M  AHS  are 
teachers  and  advisors  as  well  as  clini- 
cians, and  their  philosophy  is  to  offer 
the  best  possible  medical  care  as  a 
teaching  as  well  as  a  therapeutic 
medium.  Along  this  same  theme  is  their 
feeling  about  stringently  observed 
doctor-patient  confidentiality.  No  infor- 
mation about  your  consultations  is  re- 
leased to  others  without  your  written 
permission. 

At  some  time  during  your  medical 
school  career,  you  may  find  yourself 
seeking  advice,  counseling,  or  even 
therapy  for  a  personal  question  or  emo- 
tional problem.  Medical  education  has 
gone  through  numerous  phases  of 
change  since  the  days  of  Hippocrates, 
but  whatever  guise  it  has  assumed,  it 
has  always  involved  an  intimacy  of  sub- 
ject matter  and  interpersonal  relation- 
ship that  entails  emotional  stress.  You 
will  not  be  the  first  medical  student  to 
have  felt  the  emotional  impact,  nor  will 
you  be  the  last,  so  you  need  not  feel  it 
to  be  a  reflection  on  your  capability  or 
stability. 

As  you  enter  Medical  School,  you  come 
into  what  for  you  may  be  a  new,  excit- 
ing, perhaps  strange  and  unknown 
world  —  the  world  of  medicine.  One  can 
imagine  a  wide  scope  of  anxieties  that  a 
new  medical  student  may  experience. 
Your  classmates  will  be  coming  from 
many  different  colleges,  and  many  of 
you  may  be  the  sole  representatives  of 
your  respective  colleges.  You  may  be 
severing  old  ties,  giving  up  a  former 
group  identification  for  an  as  yet  un- 
formed one,  and  though  many  new 
friendships  will  be  coming  your  way,  the 
anxiety  and  depression  of  the  separa- 
tion may  persist. 

You  may  come  with  preconceived  fan- 
tasies about  Harvard  and  about  how 
difficult  it  might  be  to  succeed  at  HMS. 
In  many  undergraduate  colleges,  com- 
petition for  grades  and  class  rank  is 
quite  intense.  At  HMS.  instead  of  letter 


or  numerical  grades  there  are  only 
three  tiers  of  evaluation  —  Excellent. 
Satisfactory,  and  Unsatisfactory.  Hope- 
fully, this  deemphasis  on  grades  will 
foster  learning  for  the  sake  of  learning. 
Not  knowing  where  you  stand  vis  £  vis 
your  classmates  may  cause  you  some 
concern.  The  premed  competitiveness 
may  persist  but  it  does  not  contribute  to 
effective  learning,  nor  does  it  foster 
good  interpersonal  relationships  with 
your  new  classmates.  Grades  or  no 
grades,  be  prepared  to  meet  with  a 
seemingly  endless  succession  of  tests 
as  each  department  seeks  to  determine 
how  well  it  has  taught  and  how  much 
you  have  learned.  Anxiety  will  accom- 
pany your  preparation,  and  you  may 
approach  each  test  with  apprehension 
—  but  is  this  any  different  from  what 
you  experienced  in  college? 

During  your  preclinical  years  you  will  be 
thrown  together  with  your  classmates 
much  more  than  you  were  in  under- 
graduate college,  with  its  individually 
tailored  program  of  courses.  An  inti- 
macy is  fostered  that  some  find  to  be 
pleasant  and  comfortable  but  that 
others  feel  as  a  strain  on  their  ability  to 
cope.  The  increase  in  the  number  of 
women  in  the  entering  classes  no 
longer  permits  their  image  as  "the  nic- 
est guys  in  the  class."  Emotional 
reorientation  is  necessary  for  both 
women  and  men  to  see  themselves  and 
each  other  as  social  beings  as  well  as 
medical  students,  to  have  both  social 
and  professional  relationships.  And,  of 
course,  in  these  roles,  more  mature 
demands  are  faced  than  had  been  met 
before. 

"Second-year  medical  students  syn- 
drome" is  traditional  in  repute  but 
apochryphal  in  reality.  You  are  sup- 
posed to  develop  every  disease  you 
study,  but  you  need  not  sleep  anxiously 
on  this  score.  The  usual  experience  has 
been  to  be  worried  and  to  wonder  about 
some  symptoms  but  then  to  dismiss 
them  as  irrelevant.  Only  an  occasional 
student  takes  the  syndrome  seriously. 

There  are  other  anxieties  that  await  you 
during  your  medical  school  career  after 
you  have  weathered  the  high  winds  of 
course  lectures  and  the  squalls  of  the 
frequent  tests.  When  you  go  on  to  Ex- 
amination of  the  Patient  Introduction  to 
the  Clinic,  you  will  have  your  first  per- 
sonal exposure  to  the  role  of  the  physi- 
cian. Coupled  with  the  eager  anticipa- 


tion is  the  uneasiness  about  how  to  ap- 
proach a  patient  —  what  does  one  say? 
What  does  one  do?  How  will  one  be  re- 
ceived by  the  patient?  As  a  future 
physician?  Or  as  a  student  who  does 
not  know  what  it's  all  about?  This  ex- 
perience introduces  you  to  the  emo- 
tional and  mental  as  well  as  physical 
pressures  of  the  clinical  years  which 
are  themselves  punctuated  by  Parts  I  & 
II  of  the  National  Board  Exams. 

A  stressful  period  unique  to  the  fourth 
year  class  involves  hospital  visiting,  in- 
ternship applications,  and  finally  Intern- 
ship Matching  Day.  Matching  Day  is 
greeted  with  cheers  or  tears,  after 
which  the  realization  of  the  hard- 
worked-for  ambition  to  become  an  M.D. 
rapidly  approaches.  It  is  usually  tem- 
pered by  the  doubts  that  accompany  a 
new  adventure  —  this  time  that  of  in- 
ternship, of  actually  bearing  the 
doctor's  responsibility  for  the  health  and 
perhaps  the  life  of  the  patient. 

Married  students  are  faced  with  still 
other  problems.  The  married  student 
who  is  supported  by  and  depends  on 
the  spouse  has  inevitable  conflicts  — 
as  does  the  spouse,  who  may  react  to 
the  perception  of  being  married  to  the 
student,  who  in  turn  seems  to  be  mar- 
ried to  the  books.  During  the  clinical 
years  the  spouse  may  find  it  difficult  to 
cope  with  the  long  hours  and  the  every 
other  or  every  third  night  on  duty  of  the 
major  clinical  clerkships. 

There  are  numerous  other  concerns 
that  you  may  have  about  Harvard  Med- 
ical School  and  its  effect  on  your  social 
life.  You  may  feel  that  it  restricts  the  de- 
velopment of  new  outside  friendships 
and  perhaps  that  it  creates  psychologi- 
cal distance  between  you  and  your  old 
acquaintances.  Until  you  discover  how 
best  to  apportion  your  time,  you  may 
complain  that  study  demands  so  much 
of  your  time  that  you  feel  narrowed  in 
your  cultural,  athletic,  and  social  in- 
terests. 

And,  of  course,  there  are  any  number  of 
personal  questions  that  are  not  unique 
to  the  medical  student  but  for  which  you 
may  seek  answers:  family,  social,  sex- 
ual, career  choice,  etc.  All  the  M  AHS 
staff  physicians  are  ready  to  help  with 
professional  advice. 


34 


If 

The 

<Vew  EngjMf 
mal  of  Mai' 


Since  1812,  The  New  England  Journal  of  Medicine  has 
played  its  role  in  medical  circles — reporting  the  progress 
of  medicine  to  physicians  and  medical  students  through- 
out the  world. 


The  new  England  Journal  of  medicine 

10   SHATTUCK   STREET,  BOSTON.  MASSACHUSETTS   02115 


after  taking  a 

potent  analgesic 
360  times 
in  3  months, 


how  big  a  dose  will  now 
wing  relief  if  it  is  a  narcotic? 

"Tolerance  is  an  ever-present  hazard  to  continued  use 
of  narcotics. . .  .The  very  first  dose  diminishes  the 
effects  of  subsequent  doses."1  And,  as  increasing 
amounts  of  narcotics  are  required  to  control  pain,  dis- 
tressing adverse  effects  — lethargy,  hypotension,  con- 
stipation, etc.— can  needlessly  debilitate  the  patient. 

1.  Sadove,  M.  S.:  A  look  at  narcotic  and  non-narcotic  analgesics, 
Postgrad.  Med.  49:102,  June  1971. 

how  big  a  dose  wil  1  now 
bring  relief  if  it  is  Talwin  ? 

Chances  are,  the  same  50  mg.  Talwin  Tablet  you  pre- 
scribe originally  will  continue  to  provide  good  pain 
relief.  Talwin  can  be  compared  to  codeine  in  analgesic 
efficacy:  one  50  mg.  tablet  appears  equivalent  in  anal- 
gesic effect  to  60  mg.  (1  gr.)  of  codeine.  However, 
patients  receiving  Talwin  Tablets  for  prolonged  periods 
face  fewer  of  the  consequences  you've  come  to  expect 
with  narcotics.  There  should  be  fewer  "adverse  effects" 
on  her  way  of  life. 

Tolerance  rare:  Tolerance  to  the  analgesic  effect  of  Talwin 
Tablets  is  rare. 

Dependence  rare:  During  three  years  of  wide  clinical  use, 
there  have  been  a  few  reports  of  dependence  and  of  with- 
drawal symptoms  with  orally  administered  Talwin.  Patients 
with  a  history  of  drug  dependence  should  be  under  close 
supervision  while  receiving  Talwin  orally. 

In  prescribing  Talwin  for  chronic  use,  the  physician  should 
take  precautions  to  avoid  increases  in  dose  by  the  patient 
and  to  prevent  the  use  of  the  drug  in  anticipation  of  pain 
rather  than  for  the  relief  of  pain.* 

Generally  well  tolerated  by  most  patients*:  Infrequently 
causes  decrease  in  blood  pressure  or  tachycardia;  rarely 
causes  respiratory  depression  or  urinary  retention;  seldom 
causes  diarrhea  or  constipation.  Acute,  transient  CNS  effects, 
described  in  product  information,  have  occurred  in  rare 
instances  following  the  use  of  Talwin  Tablets.  If  dizziness, 
lightheadedness,  nausea,  or  vomiting  is  encountered,  these 
effects  may  decrease  or  disappear  after  the  first  few  doses. 

•See  important  product  information  for  adverse  reactions,  patient 
selection,  prescribing  and  precautionary  recommendations. 


in  chronic  pain 

of  moderate  to  severe  intensity 


Talwin 

brand  of  « 

pentazocine 


50  mg. 
Tablets 


(as  hydrochloride) 


Talwin*  Tablets  brand  of  pentazocine  (as  hydrochloride) 

Analgesic  for  Oral  Use  — 

Indication:  For  the  relief  of  moderate  to  severe  pain. 

Contraindication:  Talwin  should  not  be  administered  to  patients  who  are 
hypersensitive  to  it. 

Warnings:  Drug  Dependence.  There  have  been  instances  oi  psychological 
and  physical  dependence  on  parenteral  Talwin  m  patients  with  a  history  ot 
drug  abuse  and,  rarely,  in  patients  without  such  a  history.  Abrupt  discon- 
tinuance following  the  extended  use  ot  parenteral  Talwm  has  resulted  in 
withdrawal  symptoms.  There  have  been  a  lew  reports  ot  dependence  and  ot 
withdrawal  symptoms  with  orally  administered  Talwm.  Patients  with  a  his- 
tory of  drug  dependence  should  be  under  close  supervision  while  receiving 
Talwin  orally. 

In  prescribing  Talwin  tor  chronic  use,  the  physician  should  take  precautions 
to  avoid  increases  in  dose  by  the  patient  and  to  prevent  the  use  ot  the  drug 
in  anticipation  of  pain  rather  than  tor  the  relief  ot  pain. 

Head  In/ury  and  Increased  Intracranial  Pressure.  The  respiratory  depressant 
effects  of  Talwin  and  its  potential  for  elevating  cerebrospinal  fluid  pressure 
may  be  markedly  exaggerated  in  the  presence  of  head  injury,  other  intra- 
cranial lesions,  or  a  preexisting  increase  in  intracranial  pressure.  Further- 
more, Talwin  can  produce  effects  which  may  obscure  the  clinical  course  of 
patients  with  head  injuries.  In  such  patients,  Talwin  must  be  used  with  ex- 
treme caution  and  onfy  if  its  use  is  deemed  essential. 

Usage  in  Pregnancy.  Safe  use  of  Talwin  during  pregnancy  (other  than  labor) 
has  not  been  established.  Animal  reproduction  studies  have  not  demon- 
strated teratogenic  or  embryotoxic  effects.  However,  Talwin  should  be 
administered  to  pregnant  patients  (other  than  labor)  only  when,  in  the  judg- 
ment of  the  physician,  the  potential  benefits  outweigh  the  possible  hazards. 
Patients  receiving  Talwin  during  labor  have  experienced  no  adverse  effects 
other  than  those  that  occur  with  commonly  used  analgesics.  Talwin  should 
be  used  with  caution  in  women  delivering  premature  infants. 
Acute  CNS  Manifestations.  Patients  receiving  therapeutic  doses  of  Talwin 
have  experienced,  in  rare  instances,  hallucinations  (usually  visual),  dis- 
orientation, and  confusion  which  have  cleared  spontaneously  within  a 
period  of  hours.  The  mechanism  of  this  reaction  is  not  known.  Such  patients 
should  be  very  closely  observed  and  vital  signs  checked,  if  the  drug  is  re- 
instituted  it  should  be  done  with  caution  since  the  acute  CNS  manifesta- 
tions may  recur. 

Usage  in  Children.  Because  clinical  experience  in  children  under  12  years  of 
age  is  limited, administration  of  Talwin  in  this  age  group  is  not  recommended. 
Ambulatory  Patients.  Since  sedation,  dizziness,  and  occasional  euphoria 
have  been  noted,  ambulatory  patients  should  be  warned  not  to  operate 
machinery,  drive  cars,  or  unnecessarily  expose  themselves  to  hazards. 
Precautions:  Certain  Respiratory  Conditions.  Although  respiratory  depres- 
sion has  rarely  been  reported  after  oral  administration  of  Talwin,  the  drug 
should  be  administered  with  caution  to  patients  with  respiratory  depression 
from  any  cause,  severely  limited  respiratory  reserve,  severe  bronchial 
asthma  and  other  obstructive  respiratory  conditions,  or  cyanosis. 
Impaired  Renal  or  Hepatic  Function.  Decreased  metabolism  of  the  drug  by 
the  liver  in  extensive  liver  disease  may  predispose  to  accentuation  of  side 
effects.  Although  laboratory  tests  have  not  indicated  that  Talwin  causes  or 
increases  renal  or  hepatic  impairment,  the  drug  should  be  administered 
with  caution  to  patients  with  such  impairment. 

Myocardial  Infarction.  As  with  all  drugs,  Talwin  should  be  used  with  caution 
in  patients  with  myocardial  infarction  who  have  nausea  or  vomiting. 
Biliary  Surgery.  Until  further  experience  is  gained  with  the  effects  of  Talwin 
on  the  sphincter  of  Oddi,  the  drug  should  be  used  with  caution  in  patients 
about  to  undergo  surgery  of  the  biliary  tract. 

Patients  Receiving  Narcotics.  Talwin  is  a  mild  narcotic  antagonist.  Some 
patients  previously  given  narcotics,  including  methadone  for  the  daily  treat- 
ment of  narcotic  dependence,  have  experienced  withdrawal  symptoms  after 
receiving  Talwin. 

CNS  Effect.  Caution  should  be  used  when  Talwin  is  administered  to  pa- 
tients prone  to  seizures;  seizures  have  occurred  in  a  few  such  patients  in 
association  with  the  use  of  Talwin  although  no  cause  and  effect  relationship 
has  been  established. 

Adverse  Reactions:  Reactions  reported  after  oral  administration  of  Talwin 
include  gastrointestinal:  nausea,  vomiting;  infrequently  constipation;  and 
rarely  abdominal  distress,  anorexia,  diarrhea.  CNS  effects:  dizziness,  light- 
headedness, sedation,  euphoria,  headache;  infrequently  weakness,  dis- 
turbed dreams,  insomnia,  syncope,  visual  blurring  and  focusing  difficulty, 
hallucinations  (see  Acute  CNS  Manifestations  under  WARNINGS);  and  rarely 
tremor,  irritability,  excitement,  tinnitus.  Autonomic:  sweating;  infrequently 
flushing;  and  rarely  chills.  Allergic:  infrequently  rash;  and  rarely  urticaria, 
edema  of  the  face.  Cardiovascular:  infrequently  decrease  in  blood  pressure, 
tachycardia.  Hematologic:  rarely  depression  of  white  blood  cells  (especially 
granulocytes),  usually  reversible  and  usually  associated  with  diseases  or 
other  drugs  which  are  known  to  cause  such  changes,  moderate  transient 
eosinophiha.  Other:  rarely  respiratory  depression,  urinary  retention,  toxic 
epidermal  necrolysis. 

Dosage  and  Administration:  Adults.  The  usual  initial  adult  dose  is  1  tablet 
(50  mg.)  every  three  or  four  hours.  This  may  be  increased  to  2  tablets  (100 
mg.)  when  needed.  Total  daily  dosage  should  not  exceed  600  mg. 
When  antiinflammatory  or  antipyretic  effects  are  desired  in  addition  to 
analgesia,  aspirin  can  be  administered  concomitantly  with  Talwin. 
Children  Under  12  Years  of  Age.  Since  clinical  experience  in  children  under 
12  years  of  age  is  limited,  administration  of  Talwin  in  this  age  group  Is  not 
recommended.  .      .  _  ,    . 

Duration  of  Therapy.  Patients  with  chronic  pain  who  have  received  Talwin 
orally  for  prolonged  periods  have  not  experienced  withdrawal  symptoms 
even  when  administration  was  abruptly  discontinued  (see  WARNINGS).  No 
tolerance  to  the  analgesic  effect  has  been  observed.  Laboratory  tests  of 
blood  and  urine  and  of  liver  and  kidney  function  have  revealed  no  signifi- 
cant abnormalities  after  prolonged  administration  of  Talwin. 
Overdosage:  Manifestations.  Clinical  experience  with  Talwin  overdosage  has 
been  insufficient  to  define  the  signs  of  this  condition. 

Treatment.  Oxygen,  intravenous  fluids,  vasopressors,  and  other  supportive 
measures  should  be  employed  as  indicated.  Assisted  or  controlled  ventila- 
tion should  also  be  considered.  Although  nalorphine  and  levallorphan  are 
not  effective  antidotes  for  respiratory  depression  due  to  overdosage  or  un- 
usual sensitivity  to  Talwin,  parenteral  naloxone  (Narcan»,  available  through 
Endo  Laboratories)  is  a  specific  and  effective  antagonist. 
Talwin  is  not  subject  to  narcotic  controls. 

How  Supplied:  Tablets,  peach  color,  scored.  Each  tablet  contains  Talwin 
(brand  of  pentazocine)  as  hydrochloride  equivalent  to  50  mg.  base.  Bottles 
of  100. 


Winthrop  Laboratories,  New  York,  N.Y.  10016 


HbrM/rp